Provider Demographics
NPI:1619725413
Name:PRATHER, DAJA KIARA (LCMHCA)
Entity type:Individual
Prefix:
First Name:DAJA
Middle Name:KIARA
Last Name:PRATHER
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:DAIJA
Other - Middle Name:KIARA
Other - Last Name:PRATHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCMHCA
Mailing Address - Street 1:7209 SOMERFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-6104
Mailing Address - Country:US
Mailing Address - Phone:980-208-2722
Mailing Address - Fax:
Practice Address - Street 1:4560 STATE HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075
Practice Address - Country:US
Practice Address - Phone:704-375-5354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19817101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health