Provider Demographics
NPI:1083473318
Name:DYKES, LAINEE LYNN
Entity Type:Individual
Prefix:
First Name:LAINEE
Middle Name:LYNN
Last Name:DYKES
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 1:22 JETT LOOP
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2396
Mailing Address - Country:US
Mailing Address - Phone:407-448-4893
Mailing Address - Fax:
Practice Address - Street 1:1800 PEMBROOK DR STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6378
Practice Address - Country:US
Practice Address - Phone:407-949-7997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-317228106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician