Tyrone Elijah, LCSWA

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

24366 Issued in NC

Practice address

216 Stewart Pkwy
Washington, NC 27889-4972

Phone

(252) 946-0585

Fax

(252) 946-0580

NPI assigned

Oct 13, 2014

Last updated

Dec 18, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576627200000",
    "number": "1023412558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 CHELTENHAM DR",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278342534",
            "telephone_number": "252-917-3720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 STEWART PKWY",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278894972",
            "telephone_number": "252-946-0585",
            "fax_number": "252-946-0580"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "505 Cheltenham Dr",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "NC",
            "postal_code": "278342534",
            "country_code": "US",
            "telephone_number": "252-917-3720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELIJAH",
        "first_name": "TYRONE",
        "credential": "LCSWA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-13",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "24366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Washington, NC
• Providers in Washington, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.