Basic Information
| Provider Information | |||||||||
| NPI: | 1558024265 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCPHATTER | ||||||||
| FirstName: | IMANI | ||||||||
| MiddleName: | AALIYAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3012 FALSTAFF RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276101813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196151027 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3012 FALSTAFF RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276101813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196151027 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2021 | ||||||||
| LastUpdateDate: | 01/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P016771 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.