Provider Demographics
NPI:1033567318
Name:SRALLA, ROSARIO (LPC)
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:
Last Name:SRALLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 REDBUD DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-4800
Mailing Address - Country:US
Mailing Address - Phone:361-563-9508
Mailing Address - Fax:
Practice Address - Street 1:5720 CREEDMOOR RD STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2383
Practice Address - Country:US
Practice Address - Phone:919-977-6018
Practice Address - Fax:919-300-7471
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11731101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health