Provider Demographics
NPI:1629523188
Name:LILES, DANIEL ERNEST (LCMHC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ERNEST
Last Name:LILES
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W FIRE TOWER RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8371
Mailing Address - Country:US
Mailing Address - Phone:919-966-0211
Mailing Address - Fax:
Practice Address - Street 1:108 W FIRE TOWER RD
Practice Address - Street 2:SUITE D
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-8371
Practice Address - Country:US
Practice Address - Phone:252-830-3300
Practice Address - Fax:252-830-3322
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12446101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health