Tara Renee Muma

Individual provider Active NPI Mental Health Counselor · Davidson, NC

NPI 1003527631 · NPPES record last updated Dec 5, 2022

Key facts

NPI
1003527631
Entity type
Individual (NPI type 1)
Primary specialty
Mental Health Counselor 101YM0800X
Practice address
903 Northeast Dr Ste 201
Davidson, NC 28036-7438
Phone
(704) 896-7776
NPI assigned
Dec 5, 2022
Sex
Female
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Southlake Counseling & Consulting Past
since Dec 13, 2022
Accepting new patients
Southlake Center for Self Discovery Past
since Dec 13, 2022
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Yes

Addresses

Primary practice location

903 Northeast Dr Ste 201
Davidson, NC 28036-7438

Mailing address

903 Northeast Dr Ste 201
Davidson, NC 28036-7438
Phone (704) 896-7776

Other providers in Davidson, NC

All providers in Davidson, NC · Mental Health Counselor in North Carolina

Sources for this page

Verify at the official NPI Registry.