Provider Demographics
NPI:1992288013
Name:MOMANYI, RACHEL NYABOKE (LCAS-A)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:NYABOKE
Last Name:MOMANYI
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:NYABOKE
Other - Last Name:MOGIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:406 MINGOCREST DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6700
Mailing Address - Country:US
Mailing Address - Phone:919-867-8540
Mailing Address - Fax:
Practice Address - Street 1:502 MCKNIGHT DR STE 200
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7050
Practice Address - Country:US
Practice Address - Phone:252-499-9021
Practice Address - Fax:252-499-9448
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-21304101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)