Provider Demographics
NPI:1225149487
Name:RAUB, MARIE THOMSON (MS LPC)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:THOMSON
Last Name:RAUB
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1788 HERITAGE CENTER DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587
Mailing Address - Country:US
Mailing Address - Phone:919-556-6501
Mailing Address - Fax:919-556-4933
Practice Address - Street 1:1788 HERITAGE CENTER DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-556-6501
Practice Address - Fax:919-556-4933
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5229101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC142AUOtherNC HEALTH CHOICE
NC8443Other5 COUNTY MENTAL HLTH AUTH
NC6103151Medicaid
NC142AUOtherBLUECROSSBLUESHIELD