MEDICARE: CAROLYN MITCHELL MIALES 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
1	101YP2500X	Professional Counselor	A12553	NC

General Provider Information

NPI Number	:	1194255687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN MITCHELL MIALES LPCA

Provider Business Mailing Address
First Line	:	1300 MATTHEWS MINT HILL RD
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-2306
Country	:	US
Telephone Number	:	704-548-5299
Fax Number	:

Provider Business Practice Location Address
First Line	:	1945 J N PEASE PL STE 104
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4555
Country	:	US
Telephone Number	:	704-548-5299
Fax Number	:	704-548-5292

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

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	06/15/2017

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