Provider Demographics
NPI:1295868339
Name:SARAVIA, FREDERICK R (LPA)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:R
Last Name:SARAVIA
Suffix:
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 S 17TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6626
Mailing Address - Country:US
Mailing Address - Phone:910-343-8424
Mailing Address - Fax:910-343-6989
Practice Address - Street 1:2595 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7748
Practice Address - Country:US
Practice Address - Phone:910-799-2283
Practice Address - Fax:910-791-9227
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1770101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC201516COtherMEDICARE IND