Provider Demographics
NPI:1841455144
Name:FRAGEDAKIS, TAMI MAES (PHD, LCMHC, BCB, LRT)
Entity type:Individual
Prefix:MS
First Name:TAMI
Middle Name:MAES
Last Name:FRAGEDAKIS
Suffix:
Gender:F
Credentials:PHD, LCMHC, BCB, LRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 MALDON DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-1753
Mailing Address - Country:US
Mailing Address - Phone:919-801-7250
Mailing Address - Fax:919-790-2289
Practice Address - Street 1:1210 SE MAYNARD RD STE 103
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6943
Practice Address - Country:US
Practice Address - Phone:984-664-5495
Practice Address - Fax:919-790-2289
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1673172V00000X
NC8182101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No172V00000XOther Service ProvidersCommunity Health Worker