Provider Demographics
NPI:1295273597
Name:TYRE, ANTHONY (NCC, LPC-A, LCAS-A)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:TYRE
Suffix:
Gender:M
Credentials:NCC, LPC-A, 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:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NC
Mailing Address - Zip Code:27806-0441
Mailing Address - Country:US
Mailing Address - Phone:252-495-0727
Mailing Address - Fax:
Practice Address - Street 1:417 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4827
Practice Address - Country:US
Practice Address - Phone:252-494-2061
Practice Address - Fax:252-362-0336
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23429101YA0400X
NCA13578101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)