Provider Demographics
NPI:1932655826
Name:LYLA COLLECTIVE, INC
Entity Type:Organization
Organization Name:LYLA COLLECTIVE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, NCC, LPCA
Authorized Official - Phone:252-544-1817
Mailing Address - Street 1:301 S CHURCH ST
Mailing Address - Street 2:SUITE 292
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-5755
Mailing Address - Country:US
Mailing Address - Phone:252-544-1817
Mailing Address - Fax:
Practice Address - Street 1:301 S CHURCH ST
Practice Address - Street 2:SUITE 292
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-5755
Practice Address - Country:US
Practice Address - Phone:252-544-1817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty