Provider Demographics
NPI:1619190618
Name:PERALTA, ANN E (LCMHC,LPC, LCAS)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:E
Last Name:PERALTA
Suffix:
Gender:F
Credentials:LCMHC,LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1873 QUAIL RIDGE RD APT J
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-0909
Mailing Address - Country:US
Mailing Address - Phone:252-347-7611
Mailing Address - Fax:
Practice Address - Street 1:1873 QUAIL RIDGE RD APT J
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-0909
Practice Address - Country:US
Practice Address - Phone:252-347-7611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1064101YA0400X
NC3031101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102460Medicaid
NC187388OtherMEDCOST