MEDICARE: SATION KONCHELLAH

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	A11840	NC
2	103TS0200X	School Psychologist	1068603	NC

General Provider Information

NPI Number	:	1144613043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SATION KONCHELLAH

Provider Business Mailing Address
First Line	:	PO BOX 122
Second Line	:
City	:	SEDALIA
State	:	NC
Zip	:	27342-0122
Country	:	US
Telephone Number	:	336-494-5743
Fax Number	:

Provider Business Practice Location Address
First Line	:	3709 W MARKET ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-4432
Country	:	US
Telephone Number	:	336-494-5743
Fax Number	:	866-278-9217

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

Provider Enumeration Date	:	03/17/2015
Last Update Date	:	12/05/2025

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Directions to “ SATION KONCHELLAH ” Practice Location

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