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NPI Code Detail

MEDICARE: KAITLYN RAE FRASER I MA, LPCA

MEDICARE:   KAITLYN RAE FRASER I MA, LPCA
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
1101YP2500XProfessional CounselorA13296NC

General Provider Information

NPI Number : 1154840882
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN RAE FRASER I MA, LPCA
Provider Business Mailing Address
First Line : 2124 CROWN CENTRE DR STE 400
Second Line :
City : CHARLOTTE
State : NC
Zip : 28227-7804
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2124 CROWN CENTRE DR STE 400
Second Line :
City : CHARLOTTE
State : NC
Zip : 28227-7804
Country : US
Telephone Number : 704-849-0144
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2017
Last Update Date : 09/13/2017

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Directions to “ KAITLYN RAE FRASER I MA, LPCA” Practice Location

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