Provider Demographics
NPI:1013788165
Name:LARACUENTE-ESPINAL, ANALIZ NOELIA
Entity Type:Individual
Prefix:
First Name:ANALIZ
Middle Name:NOELIA
Last Name:LARACUENTE-ESPINAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 FLAXMERE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1796
Mailing Address - Country:US
Mailing Address - Phone:704-965-5438
Mailing Address - Fax:
Practice Address - Street 1:6900 FARMINGDALE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-5551
Practice Address - Country:US
Practice Address - Phone:704-910-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional