MEDICARE: KARLI RACHEL FORD LCMHCA

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	101YM0800X	Mental Health Counselor	A20534	NC

General Provider Information

NPI Number	:	1306428370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLI RACHEL FORD LCMHCA

Provider Business Mailing Address
First Line	:	200 E 2ND AVE
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4358
Country	:	US
Telephone Number	:	704-874-1907
Fax Number	:

Provider Business Practice Location Address
First Line	:	812 W KING ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-2748
Country	:	US
Telephone Number	:	704-739-5456
Fax Number	:

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

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	09/16/2024

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