Provider Demographics
NPI:1861678377
Name:RALLI-KOUKOUTSIS, ASPASIA (MS)
Entity Type:Individual
Prefix:MRS
First Name:ASPASIA
Middle Name:
Last Name:RALLI-KOUKOUTSIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-1650
Mailing Address - Fax:704-316-1651
Practice Address - Street 1:9929 REA RD STE 201
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6439
Practice Address - Country:US
Practice Address - Phone:704-316-1650
Practice Address - Fax:704-316-1651
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NCS7444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health