MEDICARE: SYNAPSE WELLNESS & COUNSELING

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447990858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNAPSE WELLNESS & COUNSELING

Provider Business Mailing Address
First Line	:	1635 RUSTIC ARCH WAY
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-3628
Country	:	US
Telephone Number	:	704-728-3406
Fax Number	:	704-490-4671

Provider Business Practice Location Address
First Line	:	703 S MAIN ST
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28081-4915
Country	:	US
Telephone Number	:	704-412-9759
Fax Number	:	704-490-4671

Authorized Official
Title or Position	:	PROVIDER
Name	:	TAMMY DENISE GARCIA
Credential	:	NP
Telephone Number	:	704-728-3406

Provider Enumeration Date	:	04/01/2022
Last Update Date	:	04/01/2022

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