Provider Demographics
NPI:1760061832
Name:WILAIKRUAD, PHIMRAWEE (CMA, AAMA)
Entity Type:Individual
Prefix:
First Name:PHIMRAWEE
Middle Name:
Last Name:WILAIKRUAD
Suffix:
Gender:F
Credentials:CMA, AAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 ARBOR LOOP DR APT 2902
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-0379
Mailing Address - Country:US
Mailing Address - Phone:201-467-9180
Mailing Address - Fax:
Practice Address - Street 1:2331 ARBOR LOOP DR APT 2902
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-0379
Practice Address - Country:US
Practice Address - Phone:201-467-9180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician