Provider Demographics
NPI:1750042487
Name:WISE, RASHIDA LUVENIA (LCMHC-A, LCAS)
Entity type:Individual
Prefix:
First Name:RASHIDA
Middle Name:LUVENIA
Last Name:WISE
Suffix:
Gender:F
Credentials:LCMHC-A, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 W CONE BLVD STE 223
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4067
Mailing Address - Country:US
Mailing Address - Phone:336-542-2884
Mailing Address - Fax:336-542-2885
Practice Address - Street 1:2311 W CONE BLVD STE 223
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4067
Practice Address - Country:US
Practice Address - Phone:336-542-2884
Practice Address - Fax:336-542-2885
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26920101YA0400X
NCA19754101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)