Provider Demographics
NPI:1467848119
Name:NEGUSSIE-RETTA, NEGAT (CRC, LPCA)
Entity type:Individual
Prefix:
First Name:NEGAT
Middle Name:
Last Name:NEGUSSIE-RETTA
Suffix:
Gender:F
Credentials:CRC, LPCA
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 73081
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27722-3081
Mailing Address - Country:US
Mailing Address - Phone:919-885-4046
Mailing Address - Fax:919-477-1848
Practice Address - Street 1:106 W CHURCH ST
Practice Address - Street 2:SUITE H
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-9766
Practice Address - Country:US
Practice Address - Phone:919-885-4046
Practice Address - Fax:919-477-1848
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11273101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional