Basic Information
| Provider Information | |||||||||
| NPI: | 1720110869 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NJARAMBA | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | WANJIKU | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A.C.O., L.P.C, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8211 WILLOWGLEN DR | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276163346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192667784 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8211 WILLOWGLEN DR | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276163346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192667784 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 05/11/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 6103680 | 05 | NC | MEDICAID |