=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174053268
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TULANI CHARLOTTE FOX MSW,LCSWA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2017
-----------------------------------------------------
Last Update Date | 06/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6885 CLIFFDALE RD STE 202
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28314-2834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-339-0393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4512 MARTIN CIR
-----------------------------------------------------
City | AYDEN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28513-7156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-361-9605
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | P011495
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------