Provider Demographics
NPI:1952061129
Name:CURTIS, TYESHA NAYCHAE (LCAS-A)
Entity Type:Individual
Prefix:
First Name:TYESHA
Middle Name:NAYCHAE
Last Name:CURTIS
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5211 CROSSWOOD WAY APT 208
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-3705
Mailing Address - Country:US
Mailing Address - Phone:336-517-4235
Mailing Address - Fax:
Practice Address - Street 1:249 E HWY NC 54
Practice Address - Street 2:SUITE 320
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-907-3340
Practice Address - Fax:919-907-3335
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25050101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)