Provider Demographics
NPI:1619666245
Name:DUBARD, TIYE ASANTE' (LCMHCA)
Entity Type:Individual
Prefix:
First Name:TIYE
Middle Name:ASANTE'
Last Name:DUBARD
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 MATTHEWS MINT HILL RD STE 207
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-2895
Mailing Address - Country:US
Mailing Address - Phone:704-619-3490
Mailing Address - Fax:
Practice Address - Street 1:317 MATTHEWS MINT HILL RD STE 207
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2895
Practice Address - Country:US
Practice Address - Phone:704-619-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health