Individual
TY PRENTICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, NCC
Contact information
Practice address
3972 US HIGHWAY 17 BUS E STE I2, BOLIVIA, NC 28422-8698
(704) 960-7050
Mailing address
3972 US HIGHWAY 17 BUS E STE I2, BOLIVIA, NC 28422-8698
(704) 960-7050
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
NC
Other
Enumeration date
10/03/2025
Last updated
04/06/2026
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