Provider Demographics
NPI:1235211855
Name:BHATT-MACKIN, DEEPA (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:DEEPA
Middle Name:
Last Name:BHATT-MACKIN
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 EDENBERRY DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6535
Mailing Address - Country:US
Mailing Address - Phone:919-765-0062
Mailing Address - Fax:
Practice Address - Street 1:3725 NATIONAL DR STE 114
Practice Address - Street 2:NORTH HAMPTON BUILDING
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4879
Practice Address - Country:US
Practice Address - Phone:919-784-0508
Practice Address - Fax:919-784-0250
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4883101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102688Medicaid