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General NPI Number Information
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NPI Number | 1295273597
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Entity Type | Individual
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Provider Name | ANTHONY TYRE NCC, LPC-A, LCAS-A
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Gender | Male
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 01/13/2020
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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 | 252-494-2061
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Fax | 252-362-0336
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Provider Business Mailing Address
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Address Line | PO BOX 441
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City | AURORA
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State | NC
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Zip | 27806-0441
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Country | US
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Telephone | 252-495-0727
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 23429
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A13578
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License Number State | NC
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