Provider Demographics
NPI:1831929884
Name:LYONS, LATRISHA MONIQUE (LCMHCA)
Entity type:Individual
Prefix:
First Name:LATRISHA
Middle Name:MONIQUE
Last Name:LYONS
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3742 NOBLES MILL POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27801-7857
Mailing Address - Country:US
Mailing Address - Phone:252-382-1625
Mailing Address - Fax:
Practice Address - Street 1:4000 WAKE FOREST RD STE 280
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6859
Practice Address - Country:US
Practice Address - Phone:252-210-4808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19738101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health