Organization
TYSON'S CORNER HEALTH SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CASPERTINE ANNTIONELLE HAWKINS QP (CEO)
(202) 531-6736
Entity
Organization
Contact information
Practice address
482 WILLIAMSTON DR, WINTERVILLE, NC 28590-9415
(252) 217-4681
(252) 364-2631
Mailing address
8317 SIX FORKS RD, STE. 101, RALEIGH, NC 27615-2104
(252) 217-4681
(252) 364-2631
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NC
101YM0800X
Mental Health Counselor
—
NC
101YP2500X
Professional Counselor
—
NC
103T00000X
Psychologist
—
NC
103TC1900X
Counseling Psychologist
—
NC
103TP2701X
Group Psychotherapy Psychologist
—
NC
Other
Enumeration date
10/24/2012
Last updated
10/24/2012
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