1932188315 NPI number — MS. TAI A KULENIC MPS, LPC, ATR-BC

Table of content: MS. TAI A KULENIC MPS, LPC, ATR-BC (NPI 1932188315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932188315 NPI number — MS. TAI A KULENIC MPS, LPC, ATR-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KULENIC
Provider First Name:
TAI
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MPS, LPC, ATR-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932188315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
416 W. RIDGE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSE HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28458-0880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-289-2610
Provider Business Practice Location Address Fax Number:
910-289-4410
Provider Enumeration Date:
01/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  4773 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1399C . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6102118 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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