Provider Demographics
NPI:1316176720
Name:KAREIVA, ANNA NICHOLE (MT-BC, LPC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:NICHOLE
Last Name:KAREIVA
Suffix:
Gender:F
Credentials:MT-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 S 2ND ST
Mailing Address - Street 2:103
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6158
Mailing Address - Country:US
Mailing Address - Phone:616-514-0132
Mailing Address - Fax:
Practice Address - Street 1:710 MILITARY CUTOFF RD
Practice Address - Street 2:120
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-2375
Practice Address - Country:US
Practice Address - Phone:910-254-4818
Practice Address - Fax:910-254-4819
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8106101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1316176720Medicaid