MEDICARE: MR. TIMIYA SHERARD CARSON

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1902393606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMIYA SHERARD CARSON

Provider Business Mailing Address
First Line	:	2420 S HIGHWAY 29
Second Line	:
City	:	CANTONMENT
State	:	FL
Zip	:	32533-5808
Country	:	US
Telephone Number	:	850-968-3565
Fax Number	:	850-968-3565

Provider Business Practice Location Address
First Line	:	2420 S HIGHWAY 29
Second Line	:
City	:	CANTONMENT
State	:	FL
Zip	:	32533-5808
Country	:	US
Telephone Number	:	850-968-3565
Fax Number	:	850-968-3565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2018
Last Update Date	:	04/18/2018

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Directions to “ MR. TIMIYA SHERARD CARSON ” Practice Location

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