Provider Demographics
NPI:1114442381
Name:DYKES, OLAYINKA IBERONKE (LPCA #A13107)
Entity Type:Individual
Prefix:
First Name:OLAYINKA
Middle Name:IBERONKE
Last Name:DYKES
Suffix:
Gender:F
Credentials:LPCA #A13107
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 S MARTIN LUTHER KING JR DR SUITE 225
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-6401
Mailing Address - Country:US
Mailing Address - Phone:336-740-9035
Mailing Address - Fax:
Practice Address - Street 1:1922 S MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-1361
Practice Address - Country:US
Practice Address - Phone:336-464-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13107101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional