Healthcare Provider Details

I. General information

NPI: 1548498900
Provider Name (Legal Business Name): TINA K PHARR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 HASTINGS LN
ELIZABETH CITY NC
27909-3324
US

IV. Provider business mailing address

208 HASTINGS LN
ELIZABETH CITY NC
27909-3324
US

V. Phone/Fax

Practice location:
  • Phone: 252-335-9400
  • Fax:
Mailing address:
  • Phone: 252-335-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9833
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10927
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: