Provider Demographics
NPI:1588233985
Name:BADALAMENTE, EMILY ANNE ORTIZ (LCMHCA, ATR-P)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE ORTIZ
Last Name:BADALAMENTE
Suffix:
Gender:F
Credentials:LCMHCA, ATR-P
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANNE
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:626 JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-1111
Mailing Address - Country:US
Mailing Address - Phone:804-384-8293
Mailing Address - Fax:
Practice Address - Street 1:1365 WESTGATE CENTER DR STE L1
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3106
Practice Address - Country:US
Practice Address - Phone:336-448-4451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
18-339221700000X
NCA16548101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist