Provider Demographics
NPI:1811573314
Name:CAVE, TYRONE MAURICE
Entity Type:Individual
Prefix:
First Name:TYRONE
Middle Name:MAURICE
Last Name:CAVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 FAULKNER ST
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-2819
Mailing Address - Country:US
Mailing Address - Phone:757-692-0366
Mailing Address - Fax:
Practice Address - Street 1:250 GEORGIA AVE SE STE 206
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-3000
Practice Address - Country:US
Practice Address - Phone:757-692-0366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103146101YA0400X
GA1230989815132700000X
OK315103171M00000X
GA2095101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1230989815OtherCERTIFIED NUTRITION COACH
GA2095OtherCERTIFIED SUBSTANCE ABUSE COUNSELOR
VA0710103146OtherCERTIFIED SUBSTANCE ABUSE COUNSELOR
VA2095OtherCERTIFIED ADVANCE ALCOHOL AND DRUG COUNSELOR