Individual
TAMARA LIASCHENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA LCASA
Contact information
Practice address
7901 EMERALD DR, SUITE 15, EMERALD ISLE, NC 28594-2846
(252) 515-0557
Mailing address
PO BOX 5605, EMERALD ISLE, NC 28594-5605
(252) 515-0557
(252) 503-7399
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS-23381
NC
Other
Enumeration date
05/03/2017
Last updated
05/03/2017
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