Healthcare Provider Details

I. General information

NPI: 1881958692
Provider Name (Legal Business Name): TYLER C BING-LAWSON MSW, LCSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 KERNERSVILLE MEDICAL PKWY SUITE 210
KERNERSVILLE NC
27284-7155
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-564-4950
  • Fax: 336-564-4959
Mailing address:
  • Phone: 336-564-4950
  • Fax: 336-564-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP007553
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: