Provider Demographics
NPI:1588907414
Name:NYIRENDA, JOYCE PHYLLIS (LPC)
Entity type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:PHYLLIS
Last Name:NYIRENDA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:PHYLLIS
Other - Last Name:CHILONGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11721 COPPERGATE DR UNIT 109
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-9598
Mailing Address - Country:US
Mailing Address - Phone:919-830-3435
Mailing Address - Fax:
Practice Address - Street 1:219 A S. EAST STREET
Practice Address - Street 2:ASPIRE SUPPORTIVE & COUNSELING SERVICES, LLC
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-7220
Practice Address - Country:US
Practice Address - Phone:919-835-1888
Practice Address - Fax:919-835-1889
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7670101YM0800X, 101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1588907414Medicaid