Provider Demographics
NPI:1376725721
Name:BYRON, CALLIE KAY (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:KAY
Last Name:BYRON
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 FREEDOM WAY
Mailing Address - Street 2:#16
Mailing Address - City:HUBERT
Mailing Address - State:NC
Mailing Address - Zip Code:28539-3891
Mailing Address - Country:US
Mailing Address - Phone:910-326-7003
Mailing Address - Fax:
Practice Address - Street 1:3670 FREEDOM WAY
Practice Address - Street 2:#16
Practice Address - City:HUBERT
Practice Address - State:NC
Practice Address - Zip Code:28539-3891
Practice Address - Country:US
Practice Address - Phone:910-326-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional