Provider Demographics
NPI:1073800611
Name:DI RITO, PATRICIA GRAY (MA, LAPC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:GRAY
Last Name:DI RITO
Suffix:
Gender:F
Credentials:MA, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8180
Mailing Address - Country:US
Mailing Address - Phone:770-845-1646
Mailing Address - Fax:
Practice Address - Street 1:1810 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 155
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8180
Practice Address - Country:US
Practice Address - Phone:770-845-1646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-04
Last Update Date:2011-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002775101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional