Healthcare Provider Details

I. General information

NPI: 1407482284
Provider Name (Legal Business Name): LYB COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 RUSSELL PKWY STE D
WARNER ROBINS GA
31088-7644
US

IV. Provider business mailing address

1412A RUSSELL PKWY # 219
WARNER ROBINS GA
31088-5583
US

V. Phone/Fax

Practice location:
  • Phone: 478-220-9865
  • Fax: 478-202-7491
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LAKISHA YVETTE BROOKS
Title or Position: OWNER/PROVIDER
Credential: LCSW
Phone: 240-603-3837