Provider Demographics
NPI:1952842007
Name:RENGIFO, JOSEPH (LCMHC, LCAS, CSI)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:RENGIFO
Suffix:
Gender:M
Credentials:LCMHC, LCAS, CSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 MARKET ST STE 4
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1426
Mailing Address - Country:US
Mailing Address - Phone:910-777-5575
Mailing Address - Fax:910-777-5273
Practice Address - Street 1:3825 MARKET ST STE 4
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1426
Practice Address - Country:US
Practice Address - Phone:910-777-5575
Practice Address - Fax:910-777-5273
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12895101Y00000X, 101YP2500X, 101YM0800X
NCLCAS-23186101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1396206330OtherNPI