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NPI Code Detail

MEDICARE: MR. JERRY BROOKS DYE JR.

MEDICARE: MR. JERRY BROOKS DYE JR.
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
1101YM0800XMental Health Counselor9829SC
2101YM0800XMental Health Counselor16361NC

General Provider Information

NPI Number : 1457824633
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JERRY BROOKS DYE JR.
Provider Business Mailing Address
First Line : 15801 BRIXHAM HILL AVE STE 475
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-0878
Country : US
Telephone Number : 704-251-9084
Fax Number : 877-513-7720
Provider Business Practice Location Address
First Line : 15801 BRIXHAM HILL AVE STE 475
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-0878
Country : US
Telephone Number : 704-251-9084
Fax Number : 877-513-7720
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2019
Last Update Date : 12/01/2025

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