Provider Demographics
NPI:1609516707
Name:MCBRIDE, TYSHEQUA N (LCMHCA, LCASA)
Entity Type:Individual
Prefix:
First Name:TYSHEQUA
Middle Name:N
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:LCMHCA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 TAMARACK DR APT 13302
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-3723
Mailing Address - Country:US
Mailing Address - Phone:910-386-7417
Mailing Address - Fax:
Practice Address - Street 1:1724 ROXIE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-1623
Practice Address - Country:US
Practice Address - Phone:910-778-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-27975101YA0400X
NCA17461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)