Provider Demographics
NPI:1295159549
Name:REITANO, MARY ALISON (MA, LPC, LMFT, NCC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ALISON
Last Name:REITANO
Suffix:
Gender:F
Credentials:MA, LPC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 651
Mailing Address - Street 2:
Mailing Address - City:LAKE LURE
Mailing Address - State:NC
Mailing Address - Zip Code:28746-0651
Mailing Address - Country:US
Mailing Address - Phone:704-574-3113
Mailing Address - Fax:
Practice Address - Street 1:2975 MEMORIAL HWY STE A-3
Practice Address - Street 2:
Practice Address - City:LAKE LURE
Practice Address - State:NC
Practice Address - Zip Code:28746-9249
Practice Address - Country:US
Practice Address - Phone:704-858-2926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14382101Y00000X
SC6610101Y00000X
NC1756106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist