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General NPI Number Information
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NPI Number | 1912328733
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Entity Type | Individual
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Provider Name | HOWARD WILLIAM TYAS JR. D.MIN., PHD
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Gender | Male
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Dates
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Enumeration Date | 12/20/2013
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Last Update Date | 12/20/2013
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Provider Practice Location Address
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Address Line | 1204 THE PLZ SUITE 4
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City | CHARLOTTE
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State | NC
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Zip | 28205-5053
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Country | US
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Telephone | 704-377-0688
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Fax |
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Provider Business Mailing Address
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Address Line | 2641 PALM AVE
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City | CHARLOTTE
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State | NC
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Zip | 28205-2239
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Country | US
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Telephone | 704-569-1678
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 62
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License Number State | NC
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