Provider Demographics
NPI:1710634266
Name:MUKAMILOVA, NELYA (LCMHCA, LCAS)
Entity Type:Individual
Prefix:
First Name:NELYA
Middle Name:
Last Name:MUKAMILOVA
Suffix:
Gender:F
Credentials:LCMHCA, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 SLEEPY BROOK LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-8823
Mailing Address - Country:US
Mailing Address - Phone:919-649-7762
Mailing Address - Fax:
Practice Address - Street 1:5720 CREEDMOOR RD STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2383
Practice Address - Country:US
Practice Address - Phone:919-977-6018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-27588101YA0400X
NCA16927101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)