Provider Demographics
NPI:1699086660
Name:OMARI, CONNIE YVETTE (LPC)
Entity type:Individual
Prefix:MR
First Name:CONNIE
Middle Name:YVETTE
Last Name:OMARI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 GLENWOOD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5515
Mailing Address - Country:US
Mailing Address - Phone:919-573-1835
Mailing Address - Fax:
Practice Address - Street 1:3737 GLENWOOD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5515
Practice Address - Country:US
Practice Address - Phone:919-573-1835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7919101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health