Provider Demographics
NPI:1285861286
Name:MEDINA, ROSARIO (MA)
Entity Type:Individual
Prefix:MS
First Name:ROSARIO
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 RACINE DR APT 7
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1946
Mailing Address - Country:US
Mailing Address - Phone:919-593-2395
Mailing Address - Fax:
Practice Address - Street 1:1415 W. HWY 54
Practice Address - Street 2:SUITE # 102
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5598
Practice Address - Country:US
Practice Address - Phone:919-544-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301034Medicaid