Provider Demographics
NPI:1336505627
Name:PATEL, PAYAL
Entity Type:Individual
Prefix:
First Name:PAYAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 UNIVERSITY EXEC PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3386
Mailing Address - Country:US
Mailing Address - Phone:704-716-1146
Mailing Address - Fax:
Practice Address - Street 1:8401 UNIVERSITY EXEC PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3386
Practice Address - Country:US
Practice Address - Phone:704-716-1146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-03
Last Update Date:2016-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11016A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional