Provider Demographics
NPI:1649581026
Name:LYLES, KIMBERELY JONES
Entity Type:Individual
Prefix:MR
First Name:KIMBERELY
Middle Name:JONES
Last Name:LYLES
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 1:7220 ROSE TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-3671
Mailing Address - Country:US
Mailing Address - Phone:980-226-1493
Mailing Address - Fax:
Practice Address - Street 1:7220 ROSE TERRACE CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3671
Practice Address - Country:US
Practice Address - Phone:980-226-1493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health