Provider Demographics
NPI:1336600394
Name:ESTADT, PATRICIA D (LCMHC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:ESTADT
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3173 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4184
Mailing Address - Country:US
Mailing Address - Phone:910-650-7144
Mailing Address - Fax:910-660-0526
Practice Address - Street 1:3173 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4184
Practice Address - Country:US
Practice Address - Phone:910-389-3543
Practice Address - Fax:910-660-0526
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-30
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14404101YM0800X
NCA14404101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health