Provider Demographics
NPI:1447444096
Name:TERRAGO, RITA J (PHD ABD LPC)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:J
Last Name:TERRAGO
Suffix:
Gender:F
Credentials:PHD ABD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8928 HWY 70 W BUSINESS SUITE 100
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:27520
Mailing Address - Country:US
Mailing Address - Phone:919-550-7397
Mailing Address - Fax:919-553-2543
Practice Address - Street 1:8928 HWY 70 W BUSINESS SUITE 100
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:OH
Practice Address - Zip Code:27520
Practice Address - Country:US
Practice Address - Phone:919-550-7397
Practice Address - Fax:919-553-2543
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4543101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1447444096Medicaid
NC6102497Medicaid