MEDICARE: PEMI DOMINIC LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	3297	NC

General Provider Information

NPI Number	:	1215069448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEMI DOMINIC LPC

Provider Business Mailing Address
First Line	:	PO BOX 365
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28070-0365
Country	:	US
Telephone Number	:	704-948-6649
Fax Number	:	704-948-6960

Provider Business Practice Location Address
First Line	:	10210 HICKORYWOOD HILL AVE
Second Line	:	SUITE 210
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-3332
Country	:	US
Telephone Number	:	704-948-6649
Fax Number	:	704-948-6960

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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Directions to “ PEMI DOMINIC LPC” Practice Location

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