Provider Demographics
NPI:1417404583
Name:PAQUETTE, AUDREY (LPC-A)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:PAQUETTE
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 ED DR STE 108
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8092
Mailing Address - Country:US
Mailing Address - Phone:919-324-3385
Mailing Address - Fax:919-324-3404
Practice Address - Street 1:4041 ED DR STE 108
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8092
Practice Address - Country:US
Practice Address - Phone:919-324-3385
Practice Address - Fax:919-324-3404
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA12095OtherLICENSE NUMBER