Provider Demographics
NPI:1578944104
Name:PALMA, LUIS ALEJANDRO III (CCHT, RMT)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALEJANDRO
Last Name:PALMA
Suffix:III
Gender:M
Credentials:CCHT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2666
Mailing Address - Country:US
Mailing Address - Phone:704-604-6117
Mailing Address - Fax:
Practice Address - Street 1:155 JOE KNOX AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9169
Practice Address - Country:US
Practice Address - Phone:704-604-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor