MEDICARE: LANTRIANNE E WORDEN LMHC

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	101YS0200X	School Counselor	39001995A	IN
2	101YP2500X	Professional Counselor	16431	NC

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	:	1578519781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANTRIANNE E WORDEN LMHC

Provider Business Mailing Address
First Line	:	1610 HUDSON GRAHAM LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-1009
Country	:	US
Telephone Number	:	371-354-3167
Fax Number	:	317-355-6096

Provider Business Practice Location Address
First Line	:	2315 E WT HARRIS BLVD STE 102
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-5133
Country	:	US
Telephone Number	:	704-208-4458
Fax Number	:	866-309-6385

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	02/16/2022

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