WILMINGTON MENTAL HEALTH, PLLC

Provider Demographics

• NPI: 1396206330
• Name: WILMINGTON MENTAL HEALTH, PLLC
• Entity Type: Organization
• Organization Name: WILMINGTON MENTAL HEALTH, PLLC
• Other - Org Name: WILMINGTON MENTAL HEALTH
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: PSYCHOTHERAPIST
• Authorized Official - First Name: JOSEPH
• Authorized Official - Last Name: RENGIFO
• Authorized Official - Credentials: MA, LCMHC, LCAS, CSI
• Authorized Official - Phone: 910-777-5575
• Mailing Address - Street 1: 3825 MARKET ST STE 4
• Mailing Address - City: WILMINGTON
• Mailing Address - State: NC
• Mailing Address - Zip Code: 28403-1426
• Mailing Address - Country: US
• Mailing Address - Phone: 910-777-5575
• Mailing Address - Fax: 910-777-5273
• Practice Address - Street 1: 3825 MARKET ST STE 4
• Practice Address - City: WILMINGTON
• Practice Address - State: NC
• Practice Address - Zip Code: 28403-1426
• Practice Address - Country: US
• Practice Address - Phone: 910-777-5575
• Practice Address - Fax: 910-777-5273
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2019-03-30
• Last Update Date: 2023-01-26

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261QM1300X	Ambulatory Health Care Facilities	Clinic/Center	Multi-Specialty	Group - Multi-Specialty
No	101YA0400X	Behavioral Health & Social Service Providers	Counselor	Addiction (Substance Use Disorder)	Group - Multi-Specialty
No	101YM0800X	Behavioral Health & Social Service Providers	Counselor	Mental Health	Group - Multi-Specialty
No	101YP2500X	Behavioral Health & Social Service Providers	Counselor	Professional	Group - Multi-Specialty
No	104100000X	Behavioral Health & Social Service Providers	Social Worker		Group - Multi-Specialty
No	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical	Group - Multi-Specialty
No	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	261QM0801X	Ambulatory Health Care Facilities	Clinic/Center	Mental Health (Including Community Mental Health Center)	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty
No	363LP0808X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Psychiatric/Mental Health	Group - Multi-Specialty
No	363LP2300X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Primary Care	Group - Multi-Specialty