Provider Demographics
NPI:1215080528
Name:UNNITHAN, RADHIKA (MA, LPA)
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:UNNITHAN
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E INNES ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-5010
Mailing Address - Country:US
Mailing Address - Phone:704-630-4673
Mailing Address - Fax:704-630-4663
Practice Address - Street 1:204 E INNES ST
Practice Address - Street 2:SUITE 260
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-5010
Practice Address - Country:US
Practice Address - Phone:704-630-4673
Practice Address - Fax:704-630-4663
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1965103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107043Medicaid