Provider Demographics
NPI:1437724911
Name:DUKE, TIMYRA LAVANA (LCSW-A, LCAS-A)
Entity type:Individual
Prefix:
First Name:TIMYRA
Middle Name:LAVANA
Last Name:DUKE
Suffix:
Gender:F
Credentials:LCSW-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 1:5000 FALLS OF NEUSE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5480
Mailing Address - Country:US
Mailing Address - Phone:919-865-8710
Mailing Address - Fax:919-784-9184
Practice Address - Street 1:5000 FALLS OF NEUSE RD STE 300
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5480
Practice Address - Country:US
Practice Address - Phone:919-865-8710
Practice Address - Fax:919-784-9184
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-27411101YA0400X
NC101YA0400X, 1041C0700X
101YA0400X, 1041C0700X
NC27411101YA0400X
NCP0166601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)