Individual provider Active NPI

Tiye Asante' Dubard, LCMHCA

  • Mental Health Counselor
  • Matthews, NC
National Provider Identifier
1619666245
Registry record updated Jun 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
A18668 Issued in NC
Practice address
317 Matthews Mint Hill Rd Ste 207
Matthews, NC 28105-2895
Phone
(704) 619-3490
NPI assigned
May 1, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X A18668 NC Primary

Addresses

Primary practice location

317 Matthews Mint Hill Rd Ste 207
Matthews, NC 28105-2895

Mailing address

317 Matthews Mint Hill Rd Ste 207
Matthews, NC 28105-2895
Phone (704) 619-3490

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
A18668NCMDMental Health Counselor

NPI Registry JSON

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

{
    "created_epoch": "1682899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1619666245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 MATTHEWS MINT HILL RD STE 207",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281052895",
            "telephone_number": "704-619-3490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 MATTHEWS MINT HILL RD STE 207",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281052895",
            "telephone_number": "704-619-3490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUBARD",
        "first_name": "TIYE",
        "middle_name": "ASANTE'",
        "credential": "LCMHCA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-01",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A18668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Matthews, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2023; 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.