Individual
JOANNA R DESUPINSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10580 LIGON MILL RD STE 210, WAKE FOREST, NC 27587-6090
(919) 263-9592
Mailing address
4545 S 86TH ST, LINCOLN, NE 68526-9227
(402) 483-6990
(402) 483-7045
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
4832
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598013591
—
NC
Enumeration date
08/22/2012
Last updated
10/23/2018
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