Provider Demographics
NPI:1467990143
Name:PARVATHANENI, ANU (MASTER OF SCIENCE)
Entity Type:Individual
Prefix:
First Name:ANU
Middle Name:
Last Name:PARVATHANENI
Suffix:
Gender:F
Credentials:MASTER OF SCIENCE
Other - Prefix:
Other - First Name:ANNAPURNA
Other - Middle Name:
Other - Last Name:PARVATHANENI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3125 KATHLEEN AVE
Mailing Address - Street 2:SUITE 152
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7819
Mailing Address - Country:US
Mailing Address - Phone:336-686-9891
Mailing Address - Fax:
Practice Address - Street 1:208 E BESSEMER AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6320
Practice Address - Country:US
Practice Address - Phone:336-686-9891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10876101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional