MEDICARE: PATRICIA RAGLAND LYERLY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	C002244	NC
2	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6991A	OTHER	NC	BCBS PROVIDER ID

General Provider Information

NPI Number	:	1710927900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA RAGLAND LYERLY LCSW

Provider Business Mailing Address
First Line	:	314 MOCKSVILLE AVE
Second Line	:
City	:	SALISBURY
State	:	NC
Zip	:	28144-3328
Country	:	US
Telephone Number	:	704-639-9973
Fax Number	:	704-639-0869

Provider Business Practice Location Address
First Line	:	314 MOCKSVILLE AVE
Second Line	:
City	:	SALISBURY
State	:	NC
Zip	:	28144-3328
Country	:	US
Telephone Number	:	704-639-9973
Fax Number	:	704-639-0869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	11/19/2018

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