Basic Information
| Provider Information | |||||||||
| NPI: | 1578519781 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WORDEN | ||||||||
| FirstName: | LANTRIANNE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1610 HUDSON GRAHAM LN | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282161009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3713543167 | ||||||||
| FaxNumber: | 3173556096 | ||||||||
| Practice Location | |||||||||
| Address1: | 2315 E WT HARRIS BLVD STE 102 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282135133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042084458 | ||||||||
| FaxNumber: | 8663096385 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 02/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YS0200X | 39001995A | IN | N | Behavioral Health & Social Service Providers | Counselor | School | 101YP2500X | 16431 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 100270530A | 05 | IN | MEDICAID |