Provider Demographics
NPI:1952739393
Name:CONNORS, TARA (MSED, LPCA, NCC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:CONNORS
Suffix:
Gender:F
Credentials:MSED, LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3839 CARY GLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-1872
Mailing Address - Country:US
Mailing Address - Phone:919-480-0867
Mailing Address - Fax:
Practice Address - Street 1:130 COMMERCE PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7966
Practice Address - Country:US
Practice Address - Phone:919-772-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional