Provider Demographics
NPI:1154069508
Name:ALTA TERRA COUNSELING PLLC
Entity Type:Organization
Organization Name:ALTA TERRA COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:LARICCHIUTI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:919-666-7097
Mailing Address - Street 1:838 STATE FARM ROAD
Mailing Address - Street 2:SUITE #1, ROOM #13
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607
Mailing Address - Country:US
Mailing Address - Phone:919-666-7097
Mailing Address - Fax:
Practice Address - Street 1:838 STATE FARM RD STE 1
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5364
Practice Address - Country:US
Practice Address - Phone:919-666-7097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty