Provider Demographics
NPI:1316599160
Name:DORSEY, TYEASIA K (CSAC, LCAS)
Entity Type:Individual
Prefix:
First Name:TYEASIA
Middle Name:K
Last Name:DORSEY
Suffix:
Gender:F
Credentials:CSAC, LCAS
Other - Prefix:MRS
Other - First Name:TYEASIA
Other - Middle Name:KIAH
Other - Last Name:DORSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TYEASIA DORSEY CSAC
Mailing Address - Street 1:2054 FISHPOND RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-8852
Mailing Address - Country:US
Mailing Address - Phone:252-814-5095
Mailing Address - Fax:
Practice Address - Street 1:201 E PITT ST STE 103
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-5137
Practice Address - Country:US
Practice Address - Phone:252-378-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14234101YA0400X
NC21899103TP2701X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00586698Medicaid