Provider Demographics
NPI:1891353934
Name:TYLER, JUAN (MSW, LCSW-A, LCAS-A)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:TYLER
Suffix:
Gender:M
Credentials:MSW, LCSW-A, LCAS-A
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:JAVIER
Other - Last Name:TYLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW-A, LCAS-A
Mailing Address - Street 1:33 DARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1343
Mailing Address - Country:US
Mailing Address - Phone:910-782-8752
Mailing Address - Fax:
Practice Address - Street 1:33 DARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1343
Practice Address - Country:US
Practice Address - Phone:910-782-8752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0130891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical