Iyabosola Ajani, MA, LPCA
Individual provider Active NPI Professional Counselor · Raleigh, NC
NPI 1467974162 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1467974162
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- A11630 (NC)
- Practice address
- 4406 Stonewall Dr
Raleigh, NC 27604-4957 - Phone
- (919) 272-1670
- NPI assigned
- Jul 13, 2017
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240307000363 | NC | Practitioner - Mental Health Counselor | 5395181838 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A11630 | NC | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mindly Group, PLLC | Current |
Accepting new patients |
Locations
501 Keisler Dr
Ste 104
Cary, NC 27518
Phone (919) 617-9656
8406 Six Forks Rd
Ste 204
Raleigh, NC 27615
Phone (919) 617-9656
8406 Six Forks Rd
Ste 201
Raleigh, NC 27615
Phone (919) 617-9656
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | A11630 | NC | Yes |
Addresses
Primary practice location
4406 Stonewall Dr
Raleigh, NC 27604-4957
Mailing address
4406 Stonewall Dr
Raleigh, NC 27604-4957
Phone (919) 272-1670
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All providers in Raleigh, NC · Professional Counselor in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.