MEDICARE: KATHERYN JOY TANDON M.A. L.P.C

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	101YP2500X	Professional Counselor	5453	NC

General Provider Information

NPI Number	:	1588821680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERYN JOY TANDON M.A. L.P.C

Provider Business Mailing Address
First Line	:	2525 RAEFORD ROAD
Second Line	:	SUITE C
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305
Country	:	US
Telephone Number	:	910-438-0947
Fax Number	:	910-438-0906

Provider Business Practice Location Address
First Line	:	2525 RAEFORD RD
Second Line	:	SUITE C
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5091
Country	:	US
Telephone Number	:	910-438-0947
Fax Number	:	910-438-0906

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

Provider Enumeration Date	:	05/18/2008
Last Update Date	:	05/28/2014

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