Provider Demographics
NPI:1174142277
Name:WOULLARD, TOVAKYSHE (LCSWA LCAS-A)
Entity type:Individual
Prefix:
First Name:TOVAKYSHE
Middle Name:
Last Name:WOULLARD
Suffix:
Gender:F
Credentials:LCSWA LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 SCHOOL HOUSE CMNS # 174
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7510
Mailing Address - Country:US
Mailing Address - Phone:704-639-2322
Mailing Address - Fax:
Practice Address - Street 1:700 N CANNON BLVD # 106
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-3798
Practice Address - Country:US
Practice Address - Phone:980-206-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-26152101YA0400X
NCP0144531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)