Provider Demographics
NPI:1124514757
Name:TAMAYO, RALPH ANDREW (LPA)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:ANDREW
Last Name:TAMAYO
Suffix:
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:RALPH ANDREW ROMAN
Other - Middle Name:BERMEJO
Other - Last Name:TAMAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:WEST COUNSELING, 2324 CONCORD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-6936
Mailing Address - Country:US
Mailing Address - Phone:910-337-8618
Mailing Address - Fax:
Practice Address - Street 1:2324 CONCORD LAKE RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2814
Practice Address - Country:US
Practice Address - Phone:704-829-1343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5370103TH0100X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service