Provider Demographics
NPI:1134316557
Name:TACK, FRANCES ERNESTINE (MS, LPC, LCAS, CCS)
Entity Type:Individual
Prefix:
First Name:FRANCES
Middle Name:ERNESTINE
Last Name:TACK
Suffix:
Gender:F
Credentials:MS, LPC, LCAS, CCS
Other - Prefix:
Other - First Name:FRANKIE
Other - Middle Name:
Other - Last Name:TACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC, LCAS, CCS
Mailing Address - Street 1:PO BOX 35009
Mailing Address - Street 2:BELK 3157
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28235-5009
Mailing Address - Country:US
Mailing Address - Phone:704-330-6749
Mailing Address - Fax:704-330-6410
Practice Address - Street 1:1335 ELIZABETH AVE.
Practice Address - Street 2:BELK 3157
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28235-5009
Practice Address - Country:US
Practice Address - Phone:704-330-6749
Practice Address - Fax:704-330-6410
Is Sole Proprietor?:No
Enumeration Date:2007-09-30
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC 2763101Y00000X
NCLCAS 675101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102860Medicaid