Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 167 | NC |
N | 101YS0200X | School Counselor | NC |
NPI | 1083918254 |
---|---|
Provider Name | Mrs. Colleen Dougherty Raper |
First Address | Wilson, NC 27896-8975 |
Second Address | Wilson, NC 27896-8975 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2011 |
Last Update Date | 01/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6112231 | (05) | NC |