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General NPI Number Information
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NPI Number | 1831442110
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Entity Type | Organization
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Legal Business Name | TYSON'S CORNER HEALTH SERVICES, INC
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 482 WILLIAMSTON DR
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City | WINTERVILLE
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State | NC
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Zip | 28590-9415
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Country | US
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Telephone | 252-217-4681
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Fax | 252-364-2631
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Provider Business Mailing Address
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Address Line | 8317 SIX FORKS RD STE. 101
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City | RALEIGH
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State | NC
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Zip | 27615-2104
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Country | US
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Telephone | 252-217-4681
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Fax | 252-364-2631
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Authorized Official
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Title or Position | CEO
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Name | MS. CASPERTINE ANNTIONELLE HAWKINS
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Credential | QP
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Telephone | 202-531-6736
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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 |
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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 |
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License Number State | NC
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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 | NC
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State | NC
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Taxonomy #6
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State | NC
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Taxonomy #7
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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 | NC
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