MEDICARE: DONNA SUPPLE

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	225C00000X	Rehabilitation Counselor	697948	NC
2	101YM0800X	Mental Health Counselor	A20284	NC

General Provider Information

NPI Number	:	1417789751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA SUPPLE

Provider Business Mailing Address
First Line	:	PO BOX 2034
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27515-2034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 2034
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27515-2034
Country	:	US
Telephone Number	:	919-244-4018
Fax Number	:

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

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	08/15/2024

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Directions to “ DONNA SUPPLE ” Practice Location

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