Provider Demographics
NPI:1457487399
Name:TYSON, JULIE LYN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LYN
Last Name:TYSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:LYN
Other - Last Name:SAXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, P-LCSW
Mailing Address - Street 1:105 LINES ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-5237
Mailing Address - Country:US
Mailing Address - Phone:336-472-5684
Mailing Address - Fax:
Practice Address - Street 1:105 LINES ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-5237
Practice Address - Country:US
Practice Address - Phone:336-472-5684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0067211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical