Individual
TYLER BROOKS KEZIAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, LCAS, CSI
Contact information
Practice address
110 W WALKER AVE, ASHEBORO, NC 27203-6760
(336) 633-7000
(336) 625-3817
Mailing address
284 EXECUTIVE PARK DR, SUITE 100, CONCORD, NC 28025-1831
(704) 939-1100
(704) 939-1173
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
7792
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
1889
NC
Other
Enumeration date
04/27/2010
Last updated
05/09/2017
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