Provider Demographics
NPI:1659882413
Name:BYRON, KONJE Y (LPCA)
Entity Type:Individual
Prefix:
First Name:KONJE
Middle Name:Y
Last Name:BYRON
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 PINEVILLE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-7436
Mailing Address - Country:US
Mailing Address - Phone:347-742-4574
Mailing Address - Fax:
Practice Address - Street 1:345 PINEVILLE FOREST DR
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-7436
Practice Address - Country:US
Practice Address - Phone:347-742-4574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12865101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health