Healthcare Provider Details

I. General information

NPI: 1508543786
Provider Name (Legal Business Name): LOLA TASAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3622 LYCKAN PKWY STE 5007
DURHAM NC
27707-2539
US

IV. Provider business mailing address

102 BUCK TAYLOR TRL
CHAPEL HILL NC
27516-7763
US

V. Phone/Fax

Practice location:
  • Phone: 783-691-9884
  • Fax:
Mailing address:
  • Phone: 559-210-4229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP018727
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: