Provider Demographics
NPI:1407313752
Name:NEVILLE, RAITESHA (LCSW)
Entity Type:Individual
Prefix:
First Name:RAITESHA
Middle Name:
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 CURTIS ELLIS DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2237
Mailing Address - Country:US
Mailing Address - Phone:252-266-0128
Mailing Address - Fax:
Practice Address - Street 1:518 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-5657
Practice Address - Country:US
Practice Address - Phone:252-567-8619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0132241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical