Provider Demographics
NPI:1528691631
Name:VENKATAGANESAN, VIDYA (LCMHCA, NCC)
Entity type:Individual
Prefix:
First Name:VIDYA
Middle Name:
Last Name:VENKATAGANESAN
Suffix:
Gender:F
Credentials:LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5029 LAKE GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6413
Mailing Address - Country:US
Mailing Address - Phone:919-282-6240
Mailing Address - Fax:
Practice Address - Street 1:5029 LAKE GROVE BLVD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-6413
Practice Address - Country:US
Practice Address - Phone:919-282-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NCA20059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician