Provider Demographics
NPI:1174960272
Name:BIALECK, TANIA MARIE (MA, NCC, LPC)
Entity type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:MARIE
Last Name:BIALECK
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N CANTERBURY ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211
Mailing Address - Country:US
Mailing Address - Phone:704-621-7652
Mailing Address - Fax:
Practice Address - Street 1:207 S BROAD STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115
Practice Address - Country:US
Practice Address - Phone:800-311-7072
Practice Address - Fax:704-621-7652
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8563101YP2500X
NC8563101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1174960272Medicaid