Doctor Name: | TARA CANTRELL |
NPI Number: | 1194179291 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPCA |
License Number: | A12036 |
Business Practice Address: | 95 Foggy Mountain Rd Horse Shoe, NC - 287429516 |
Business Phone Number: | 8286746411 |
Business Fax Number: | |
Mailing Address: | 95 Foggy Mountain Rd, HORSE SHOE |
State: | NC |
Postal Code: | 287429516 |
Phone Number: | 8286746411 |
Fax Number: | |
NPI Enumeration Date: | 04/15/2016 |
NPI Last Update Date: | 04/15/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | A12036 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |