Healthcare Provider Details

I. General information

NPI: 1144109877
Provider Name (Legal Business Name): DIANCA CHERYSE TYSON LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 WHITNEY AVE UNIT 6
HAMDEN CT
06518-2340
US

IV. Provider business mailing address

25 FRANKLIN RD APT B
HAMDEN CT
06517-3638
US

V. Phone/Fax

Practice location:
  • Phone: 203-278-6989
  • Fax: 203-651-1462
Mailing address:
  • Phone: 203-278-6989
  • Fax: 203-286-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9349
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: