Provider Demographics
NPI:1730832676
Name:MYERS-BECK, TONI MARIE
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:MARIE
Last Name:MYERS-BECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WAKE FOREST UNIVERSITY HEALTH SCIENCES
Mailing Address - Street 2:100 KIMEL FOREST DRIVE
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-713-0947
Mailing Address - Fax:
Practice Address - Street 1:319 WESTWOOD AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4323
Practice Address - Country:US
Practice Address - Phone:336-878-6419
Practice Address - Fax:336-878-6420
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0085421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical