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General NPI Number Information
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NPI Number | 1417452665
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Entity Type | Individual
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Provider Name | TARA M. SOLDANO-DAVIS M.A., LPC-A
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Gender | Female
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 11023 ROYAL COLONY DR
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City | WAXHAW
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State | NC
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Zip | 28173-6783
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Country | US
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Telephone | 704-256-9302
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Fax |
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Provider Business Mailing Address
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Address Line | 11023 ROYAL COLONY DR
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City | WAXHAW
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State | NC
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Zip | 28173-6783
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Country | US
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Telephone | 704-256-9302
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A13858
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License Number State | NC
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