Provider Demographics
NPI:1508584848
Name:MENCHACA, RUBY (MS, LCMHCA)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:MENCHACA
Suffix:
Gender:F
Credentials:MS, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 YORK LN
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-7763
Mailing Address - Country:US
Mailing Address - Phone:915-613-9349
Mailing Address - Fax:
Practice Address - Street 1:1133 MILITARY CUTOFF RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3684
Practice Address - Country:US
Practice Address - Phone:910-516-8003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health