Provider Demographics
NPI:1225389372
Name:GUY, TONYA SHAMEEKA SHYREL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:SHAMEEKA SHYREL
Last Name:GUY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 FOREST GROVE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1023
Mailing Address - Country:US
Mailing Address - Phone:704-968-4769
Mailing Address - Fax:
Practice Address - Street 1:2629 FOREST GROVE CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1023
Practice Address - Country:US
Practice Address - Phone:704-968-4769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0079691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6009199Medicaid