MEDICARE: TARCHA BURRELL

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1285445239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARCHA BURRELL

Provider Business Mailing Address
First Line	:	2008 QUAIL RIDGE RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-4138
Country	:	US
Telephone Number	:	919-376-5867
Fax Number	:

Provider Business Practice Location Address
First Line	:	2008 QUAIL RIDGE RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609
Country	:	US
Telephone Number	:	919-376-5867
Fax Number	:

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

Provider Enumeration Date	:	01/17/2025
Last Update Date	:	01/17/2025

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