Provider Demographics
NPI:1336851120
Name:RAJAN, MALLIKA (MA, LCMHCA)
Entity Type:Individual
Prefix:
First Name:MALLIKA
Middle Name:
Last Name:RAJAN
Suffix:
Gender:F
Credentials:MA, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11020 S TRYON ST STE 408
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-6662
Mailing Address - Country:US
Mailing Address - Phone:980-236-1660
Mailing Address - Fax:
Practice Address - Street 1:11020 S TRYON ST STE 408
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6662
Practice Address - Country:US
Practice Address - Phone:980-236-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16403101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty