Provider Demographics
NPI:1720622491
Name:CONYERS, TYSHEENA PATRICE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TYSHEENA
Middle Name:PATRICE
Last Name:CONYERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WINDY WAY
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1846
Mailing Address - Country:US
Mailing Address - Phone:419-559-9730
Mailing Address - Fax:
Practice Address - Street 1:25 S OLD BALTIMORE PIKE STE 201
Practice Address - Street 2:
Practice Address - City:CHRISTIANA
Practice Address - State:DE
Practice Address - Zip Code:19702-1540
Practice Address - Country:US
Practice Address - Phone:302-266-6200
Practice Address - Fax:302-266-6212
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00017231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEQ1-0001723OtherDELAWARE BOARD OF SOCIAL WORK EXAMINERS