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General NPI Number Information
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NPI Number | 1104783612
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Entity Type | Organization
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Legal Business Name | 4.1.7 COUNSELING, PLLC
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 417 N BRIDGE ST
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City | WASHINGTON
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State | NC
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Zip | 27889-4827
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Country | US
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Telephone | 252-481-1007
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Fax |
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Provider Business Mailing Address
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Address Line | 3231 IDALIA RD
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City | AURORA
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State | NC
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Zip | 27806-9525
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Country | US
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Telephone | 252-481-1007
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ANTHONY TYRE
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Credential | LCMHC
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Telephone | 252-481-1007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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