| Doctor Name: | TYE WALCOTT |
| NPI Number: | 1003109984 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | LPC006467 |
| Business Practice Address: | 125 Fahm St Savannah, GA - 314012391 |
| Business Phone Number: | 9123449403 |
| Business Fax Number: | |
| Mailing Address: | 3441 Cypress Mill Rd, Suite 102 BRUNSWICK |
| State: | GA |
| Postal Code: | 315202878 |
| Phone Number: | 9122640979 |
| Fax Number: | |
| NPI Enumeration Date: | 05/25/2011 |
| NPI Last Update Date: | 10/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC006467 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |