Provider Demographics
NPI:1245652643
Name:DHOLAKIA, DHRUTI (MED, LCMHC, RPT)
Entity type:Individual
Prefix:
First Name:DHRUTI
Middle Name:
Last Name:DHOLAKIA
Suffix:
Gender:F
Credentials:MED, LCMHC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 TALS ROCK WAY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-1906
Mailing Address - Country:US
Mailing Address - Phone:919-744-8819
Mailing Address - Fax:
Practice Address - Street 1:225 TALS ROCK WAY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-1906
Practice Address - Country:US
Practice Address - Phone:919-744-8819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NCA10354101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC46-4506545OtherTAX ID