Provider Demographics
NPI:1306236658
Name:BETHEA-BYRD, TONI (LCMHC, LCAS-A)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:BETHEA-BYRD
Suffix:
Gender:F
Credentials:LCMHC, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLADENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28320-5970
Mailing Address - Country:US
Mailing Address - Phone:910-755-5222
Mailing Address - Fax:910-755-5255
Practice Address - Street 1:6881 RAEFORD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2630
Practice Address - Country:US
Practice Address - Phone:910-423-6200
Practice Address - Fax:910-429-0800
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11213101YM0800X
NC20138101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)