Provider Demographics
NPI:1710927900
Name:LYERLY, PATRICIA RAGLAND (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:RAGLAND
Last Name:LYERLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:IDA
Other - Last Name:RAGLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:314 MOCKSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3328
Mailing Address - Country:US
Mailing Address - Phone:704-639-9973
Mailing Address - Fax:704-639-0869
Practice Address - Street 1:314 MOCKSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3328
Practice Address - Country:US
Practice Address - Phone:704-639-9973
Practice Address - Fax:704-639-0869
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC002244101YM0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6991AOtherBCBS PROVIDER ID
NC6002293Medicaid
NC2866545Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER