Provider Demographics
NPI:1316959380
Name:SERVENTI, INEZ MARIE (PHD, MSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:INEZ
Middle Name:MARIE
Last Name:SERVENTI
Suffix:
Gender:F
Credentials:PHD, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 OAKLEY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-8619
Mailing Address - Country:US
Mailing Address - Phone:704-806-3200
Mailing Address - Fax:704-889-5649
Practice Address - Street 1:106 OAKLEY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-8619
Practice Address - Country:US
Practice Address - Phone:704-806-3200
Practice Address - Fax:704-889-5649
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC004887101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC184757OtherMEDCOST PROVIDER NUMBER
NC140GPOtherBCBSNC PROVIDER NUMBER