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NPI Code Detail

MEDICARE: TYSHAWNA BONEY

MEDICARE: TYSHAWNA BONEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
21041C0700XClinical Social WorkerP017393NC

General Provider Information

NPI Number : 1518406206
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYSHAWNA BONEY
Provider Business Mailing Address
First Line : 8604 CLIFF CAMERON DR STE 152
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-8526
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8604 CLIFF CAMERON DR STE 152
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-8526
Country : US
Telephone Number : 910-915-6050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2017
Last Update Date : 04/28/2022

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Directions to “ TYSHAWNA BONEY ” Practice Location

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