MEDICARE: MRS. ADRIENNE DANIELS FORNEY

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	101YP2500X	Professional Counselor	12276	NC
2	101YM0800X	Mental Health Counselor	S12276	NC

General Provider Information

NPI Number	:	1932574753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ADRIENNE DANIELS FORNEY

Provider Business Mailing Address
First Line	:	14923 ALYSSA FAITH CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-7762
Country	:	US
Telephone Number	:	980-226-3236
Fax Number	:

Provider Business Practice Location Address
First Line	:	14923 ALYSSA FAITH COURT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278
Country	:	US
Telephone Number	:	980-226-3236
Fax Number	:

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

Provider Enumeration Date	:	12/04/2015
Last Update Date	:	01/27/2026

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