Provider Demographics
NPI:1306374814
Name:FOGG, RASHEEKA (LCAS, LCMHC, CSI)
Entity Type:Individual
Prefix:
First Name:RASHEEKA
Middle Name:
Last Name:FOGG
Suffix:
Gender:F
Credentials:LCAS, LCMHC, CSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 CRUTCHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2754
Mailing Address - Country:US
Mailing Address - Phone:919-560-7305
Mailing Address - Fax:
Practice Address - Street 1:309 CRUTCHFIELD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704
Practice Address - Country:US
Practice Address - Phone:919-560-7305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-28
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13634101YM0800X
NC20146101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)