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NPI Code Detail

MEDICARE: TIERRA KIRKLAND LPCA

MEDICARE: TIERRA KIRKLAND LPCA
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
1101YP2500XProfessional CounselorA11839NC

General Provider Information

NPI Number : 1841719036
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIERRA KIRKLAND LPCA
Provider Business Mailing Address
First Line : 7300 CREEKWOOD QUORUM DR APT 101
Second Line :
City : CHARLOTTE
State : NC
Zip : 28212-7565
Country : US
Telephone Number : 912-656-7216
Fax Number :
Provider Business Practice Location Address
First Line : 3622 CENTRAL AVE
Second Line :
City : CHARLOTTE
State : NC
Zip : 28205-5638
Country : US
Telephone Number : 704-980-5810
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2017
Last Update Date : 09/19/2017

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Directions to “ TIERRA KIRKLAND LPCA” Practice Location

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