Provider Demographics
NPI:1609198845
Name:IYENGAR, RANI
Entity Type:Individual
Prefix:
First Name:RANI
Middle Name:
Last Name:IYENGAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16024 GRAFHAM CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5958
Mailing Address - Country:US
Mailing Address - Phone:704-227-0669
Mailing Address - Fax:704-227-0691
Practice Address - Street 1:16024 GRAFHAM CIR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5958
Practice Address - Country:US
Practice Address - Phone:704-227-0669
Practice Address - Fax:704-227-0691
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1559101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)