Healthcare Provider Details

I. General information

NPI: 1598548109
Provider Name (Legal Business Name): TYLER LEE STOCKS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 LYNNDALE CT STE C
GREENVILLE NC
27858-5462
US

IV. Provider business mailing address

977 MAC ALLEN RD
WINTERVILLE NC
28590-7737
US

V. Phone/Fax

Practice location:
  • Phone: 252-752-8602
  • Fax: 252-752-8103
Mailing address:
  • Phone: 252-717-3350
  • Fax: 252-752-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-29052
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSTOC-J827Z3
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: