Provider Demographics
NPI:1104140441
Name:PERRY, AIMEE PANTON (LPC)
Entity type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:PANTON
Last Name:PERRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 JUNCTION BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-5263
Mailing Address - Country:US
Mailing Address - Phone:919-772-0182
Mailing Address - Fax:919-747-4202
Practice Address - Street 1:3737 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-5263
Practice Address - Country:US
Practice Address - Phone:919-772-0182
Practice Address - Fax:919-747-4202
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7754101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104474Medicaid