MEDICARE: TY'KEI SPINKS MA, LCMHC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1306439005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TY'KEI SPINKS MA, LCMHC-A

Provider Business Mailing Address
First Line	:	6011 LAKE FOREST RD E APT 206
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-1079
Country	:	US
Telephone Number	:	336-303-2461
Fax Number	:

Provider Business Practice Location Address
First Line	:	5820 E WT HARRIS BLVD STE 205
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-4032
Country	:	US
Telephone Number	:	704-469-1243
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2021
Last Update Date	:	02/22/2021

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