Provider Demographics
NPI:1134877699
Name:VICKERIE, RANIESHA CHENELLE
Entity type:Individual
Prefix:MRS
First Name:RANIESHA
Middle Name:CHENELLE
Last Name:VICKERIE
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 1:5246 PERRY OLIVER DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-2635
Mailing Address - Country:US
Mailing Address - Phone:910-922-4402
Mailing Address - Fax:
Practice Address - Street 1:5246 PERRY OLIVER DR
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-2635
Practice Address - Country:US
Practice Address - Phone:910-922-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician