Healthcare Provider Details

I. General information

NPI: 1760689566
Provider Name (Legal Business Name): LYLAN CRITES WINGFIELD M.S., NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WASHINGTON ST 301
GREENSBORO NC
27401-2957
US

IV. Provider business mailing address

301 E WASHINGTON ST 301
GREENSBORO NC
27401-2957
US

V. Phone/Fax

Practice location:
  • Phone: 336-333-6853
  • Fax:
Mailing address:
  • Phone: 336-333-6853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: