MEDICARE: MS. TAI A KULENIC MPS, LPC, ATR-BC

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	101Y00000X	Counselor	4773	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1399C	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932188315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAI A KULENIC MPS, LPC, ATR-BC

Provider Business Mailing Address
First Line	:	PO BOX 880
Second Line	:	416 W RIDGE STREET
City	:	ROSE HILL
State	:	NC
Zip	:	28458-0880
Country	:	US
Telephone Number	:	910-289-2610
Fax Number	:	910-289-4410

Provider Business Practice Location Address
First Line	:	416 W. RIDGE STREET
Second Line	:
City	:	ROSE HILL
State	:	NC
Zip	:	28458-0880
Country	:	US
Telephone Number	:	910-289-2610
Fax Number	:	910-289-4410

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	08/15/2012

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