Active NPI
Tynicia Walton, MS, MSW, LCSW, LCAS
- Clinical Social Worker
- Fayetteville, NC
National Provider Identifier
1205100930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C010674
- Practice address
- 6321 Raeford Rd
Fayetteville, NC 28304-2810 - Phone
- (910) 485-6336
- NPI assigned
- Feb 27, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 21534 | NC | |
| Clinical Social Worker | 1041C0700X | C010674 | NC | Primary |
Addresses
Primary practice location
6321 Raeford Rd
Fayetteville, NC 28304-2810
Mailing address
PO Box 1217
Hope Mills, NC 28348-1217
Phone (910) 987-6498
Other practice location 1
6977 Nexus Ct Ste 102
Fayetteville, NC 28304-2651
Phone (910) 703-8402
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0870 | Other | NC | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612310400000",
"number": "1205100930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1217",
"city": "HOPE MILLS",
"state": "NC",
"postal_code": "283481217",
"telephone_number": "910-987-6498"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6321 RAEFORD RD",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283042810",
"telephone_number": "910-485-6336"
}
],
"practiceLocations": [
{
"address_1": "6977 Nexus Ct Ste 102",
"address_purpose": "LOCATION",
"city": "Fayetteville",
"state": "NC",
"postal_code": "283042651",
"country_code": "US",
"telephone_number": "910-703-8402",
"fax_number": "910-703-8402",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALTON",
"first_name": "TYNICIA",
"credential": "MS, MSW, LCSW, LCAS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-02-27",
"last_updated": "2021-02-03",
"certification_date": "2021-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "21534",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C010674",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "0870",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.