Basic Information
| Provider Information | |||||||||
| NPI: | 1902358757 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAGGHIANTI | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS ED. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2165 SPICER CV STE 5 | ||||||||
| Address2: | MEMPHIS NORTH TREATMENT CENTER | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381345623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013727878 | ||||||||
| FaxNumber: | 9013739298 | ||||||||
| Practice Location | |||||||||
| Address1: | 2165 SPICER CV | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381345623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013727878 | ||||||||
| FaxNumber: | 9013739298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2016 | ||||||||
| LastUpdateDate: | 10/27/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.