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NPI Code Detail

MEDICARE: KATREL ALEASE CLACK THOMAS

MEDICARE: KATREL ALEASE CLACK THOMAS
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
1101YM0800XMental Health CounselorA22256NC

General Provider Information

NPI Number : 1134074230
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATREL ALEASE CLACK THOMAS
Provider Business Mailing Address
First Line : 11711 MEZZANINE DR UNIT 103
Second Line :
City : RALEIGH
State : NC
Zip : 27614-9594
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3050 BERKS WAY
Second Line :
City : RALEIGH
State : NC
Zip : 27614-6598
Country : US
Telephone Number : 919-900-7438
Fax Number : 919-900-7576
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2026
Last Update Date : 03/03/2026

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Directions to “ KATREL ALEASE CLACK THOMAS ” Practice Location

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