Healthcare Provider Details

I. General information

NPI: 1265713606
Provider Name (Legal Business Name): TYSON'S CORNER HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N GRACE ST UNIT D
ROCKY MOUNT NC
27804-4843
US

IV. Provider business mailing address

2100 N HERITAGE ST UNIT B
KINSTON NC
28501-2222
US

V. Phone/Fax

Practice location:
  • Phone: 252-407-8469
  • Fax:
Mailing address:
  • Phone: 252-407-8469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: MS. CASPERTINE HAWKINS
Title or Position: CEO
Credential:
Phone: 252-407-8469