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NPI Code Detail

MEDICARE: TANYA D PALACIOS

MEDICARE: TANYA D PALACIOS
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLCAS-23808NC
2175T00000XPeer Specialist2024-12047-01NC

General Provider Information

NPI Number : 1649016817
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANYA D PALACIOS
Provider Business Mailing Address
First Line : 415 DUNSTAN AVE STE B
Second Line :
City : DURHAM
State : NC
Zip : 27707-2390
Country : US
Telephone Number : 833-496-0445
Fax Number : 984-208-5220
Provider Business Practice Location Address
First Line : 415 DUNSTAN AVE STE B
Second Line :
City : DURHAM
State : NC
Zip : 27707-2390
Country : US
Telephone Number : 833-496-0445
Fax Number : 984-208-5220
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2024
Last Update Date : 12/09/2025

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Directions to “ TANYA D PALACIOS ” Practice Location

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