Provider Demographics
NPI:1003001330
Name:CERESA, BESS LYONS (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:BESS
Middle Name:LYONS
Last Name:CERESA
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18809 W CATAWBA AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5547
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18809 W CATAWBA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5547
Practice Address - Country:US
Practice Address - Phone:704-607-6592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1264106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist