MEDICARE: TREA LACHELLE PERRY CSAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1457602740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREA LACHELLE PERRY CSAC

Provider Business Mailing Address
First Line	:	120 HENDERSON DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-5602
Country	:	US
Telephone Number	:	910-938-9550
Fax Number	:	910-938-5912

Provider Business Practice Location Address
First Line	:	120 HENDERSON DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-5602
Country	:	US
Telephone Number	:	910-938-9550
Fax Number	:	910-938-5912

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

Provider Enumeration Date	:	09/26/2012
Last Update Date	:	09/26/2012

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