MEDICARE: THOMAS NATHANIEL WARREN M.S., L.P.C, N.C.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4387	NC

General Provider Information

NPI Number	:	1013057298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS NATHANIEL WARREN M.S., L.P.C, N.C.C.

Provider Business Mailing Address
First Line	:	3598 CARRIAGE FARM RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-8244
Country	:	US
Telephone Number	:	252-937-8304
Fax Number	:	252-937-5520

Provider Business Practice Location Address
First Line	:	852 COUNTRY CLUB RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-1706
Country	:	US
Telephone Number	:	252-937-8304
Fax Number	:	252-937-5520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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