Provider Demographics
NPI:1932188315
Name:KULENIC, TAI A (MPS, LPC, ATR-BC)
Entity type:Individual
Prefix:MS
First Name:TAI
Middle Name:A
Last Name:KULENIC
Suffix:
Gender:F
Credentials:MPS, LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:416 W RIDGE STREET
Mailing Address - City:ROSE HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28458-0880
Mailing Address - Country:US
Mailing Address - Phone:910-289-2610
Mailing Address - Fax:910-289-4410
Practice Address - Street 1:416 W. RIDGE STREET
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:NC
Practice Address - Zip Code:28458-0880
Practice Address - Country:US
Practice Address - Phone:910-289-2610
Practice Address - Fax:910-289-4410
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4773101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1399COtherBCBS
NC6102118Medicaid