Provider Demographics
NPI:1265808885
Name:SEGALLA, COLETTE (PHD)
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:SEGALLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 W HARGETT ST
Mailing Address - Street 2:ROOM 704
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-1357
Mailing Address - Country:US
Mailing Address - Phone:919-344-0590
Mailing Address - Fax:
Practice Address - Street 1:5 W HARGETT ST
Practice Address - Street 2:SUITE 704
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1357
Practice Address - Country:US
Practice Address - Phone:919-971-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional