Provider Demographics
NPI:1780209163
Name:MIRAKI, NADIYA (MS, LCMHC)
Entity Type:Individual
Prefix:
First Name:NADIYA
Middle Name:
Last Name:MIRAKI
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 TALS ROCK WAY STE 6
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-1925
Mailing Address - Country:US
Mailing Address - Phone:949-245-2499
Mailing Address - Fax:
Practice Address - Street 1:1915 CHAPEL HILL RD STE A
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-1177
Practice Address - Country:US
Practice Address - Phone:919-246-5664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14884101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1780209163OtherMENTAL HEALTH