Provider Demographics
NPI:1316251424
Name:PATEL, SONALI (LCAS)
Entity type:Individual
Prefix:
First Name:SONALI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4204
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27836-2204
Mailing Address - Country:US
Mailing Address - Phone:252-258-0126
Mailing Address - Fax:252-753-5121
Practice Address - Street 1:3707 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:NC
Practice Address - Zip Code:27828-1486
Practice Address - Country:US
Practice Address - Phone:252-753-5100
Practice Address - Fax:252-753-5121
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)