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Individual
TADANA PRAYER JENNETTE
Active
Individual
TADANA PRAYER JENNETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
3567
NC
101YP2500X
Professional Counselor
Primary
12098
NC
101YP2500X
Professional Counselor
A12098
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12098
LICENSED CLINICAL MENTAL HEALTH COUNSELOR
NC
01
—
3567
LICENSED CLINICAL ADDICTIONS SPECIALIST
NC
Enumeration date
09/14/2015
Last updated
10/15/2021
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