Provider Demographics
NPI:1851773121
Name:LYDIA KICKLITER, LPC, LLC
Entity Type:Organization
Organization Name:LYDIA KICKLITER, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KICKLITER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:727-643-5594
Mailing Address - Street 1:29 RAVENSCROFT DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3655
Mailing Address - Country:US
Mailing Address - Phone:727-643-5594
Mailing Address - Fax:855-355-4064
Practice Address - Street 1:29 RAVENSCROFT DR STE 102
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3655
Practice Address - Country:US
Practice Address - Phone:727-643-5594
Practice Address - Fax:855-355-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-23
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12763101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty