Provider Demographics
NPI:1043070170
Name:SPAKE, DYLAN CATHRYNE (LCSWA)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:CATHRYNE
Last Name:SPAKE
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 BARIUM SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-8453
Mailing Address - Country:US
Mailing Address - Phone:704-832-2200
Mailing Address - Fax:704-838-1541
Practice Address - Street 1:4344 S NC HIGHWAY 150 STE D
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-5376
Practice Address - Country:US
Practice Address - Phone:704-832-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0202031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical