Provider Demographics
NPI:1871185561
Name:LYLES, LAQUASHA M (LMSW)
Entity Type:Individual
Prefix:
First Name:LAQUASHA
Middle Name:M
Last Name:LYLES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9722 GROFFS MILL DR STE 955
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6341
Mailing Address - Country:US
Mailing Address - Phone:443-762-4887
Mailing Address - Fax:
Practice Address - Street 1:4654 YORK RD STE A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4726
Practice Address - Country:US
Practice Address - Phone:443-762-4887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25312104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker