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General NPI Number Information
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NPI Number | 1134316557
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Entity Type | Individual
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Provider Name | FRANCES ERNESTINE TACK MS, LPC, LCAS, CCS
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Gender | Female
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Dates
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Enumeration Date | 09/30/2007
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Last Update Date | 09/09/2010
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Provider Practice Location Address
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Address Line | 1335 ELIZABETH AVE. BELK 3157
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City | CHARLOTTE
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State | NC
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Zip | 28235-5009
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Country | US
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Telephone | 704-330-6749
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Fax | 704-330-6410
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Provider Business Mailing Address
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Address Line | PO BOX 35009 BELK 3157
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City | CHARLOTTE
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State | NC
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Zip | 28235-5009
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Country | US
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Telephone | 704-330-6749
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Fax | 704-330-6410
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC 2763
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAS 675
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License Number State | NC
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