Provider Demographics
NPI:1639620339
Name:NAGARJI, SURAJ (LPCA, NCC, MS)
Entity Type:Individual
Prefix:MRS
First Name:SURAJ
Middle Name:
Last Name:NAGARJI
Suffix:
Gender:F
Credentials:LPCA, NCC, MS
Other - Prefix:
Other - First Name:SURAJ
Other - Middle Name:GUNVANT
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCA, NCC, MS
Mailing Address - Street 1:PO BOX 1546
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28070-1546
Mailing Address - Country:US
Mailing Address - Phone:704-896-6044
Mailing Address - Fax:
Practice Address - Street 1:9820 NORTHCROSS CENTER CT
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7356
Practice Address - Country:US
Practice Address - Phone:704-896-6044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12524101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health