Provider Demographics
NPI:1932471067
Name:LYLES, SHARON BROWN (EDD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:BROWN
Last Name:LYLES
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:23944-2051
Mailing Address - Country:US
Mailing Address - Phone:434-676-8900
Mailing Address - Fax:
Practice Address - Street 1:534 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:KENBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:23944-2051
Practice Address - Country:US
Practice Address - Phone:434-676-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-0600673101Y00000X, 101YS0200X, 103T00000X, 103TS0200X, 171M00000X, 172V00000X, 174H00000X
NC1973101YS0200X, 103TS0200X
VA0813000437103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0813000437Medicaid