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NPI Code Detail

MEDICARE: RACHEL PHILLIPS TENNY MA, LPCA

MEDICARE: RACHEL PHILLIPS TENNY 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
1101YM0800XMental Health CounselorA13076NC

General Provider Information

NPI Number : 1194234088
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHEL PHILLIPS TENNY MA, LPCA
Provider Business Mailing Address
First Line : 1515 MAINLINE BLVD APT 7201
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-0522
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6633 FAIRVIEW RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3321
Country : US
Telephone Number : 704-336-1246
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2017
Last Update Date : 09/24/2017

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