Individual
GWEN DALE TYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC, NCC
Contact information
Practice address
57 TREVINO LN APT 11, STARKVILLE, MS 39759-4443
(252) 327-0407
(662) 325-3263
Mailing address
2416 CHIPPENHAM CT, WINTERVILLE, NC 28590-9773
(252) 327-0407
(662) 325-3263
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
7368
NC
Other
Enumeration date
09/29/2010
Last updated
09/29/2010
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