Healthcare Provider Details

I. General information

NPI: 1295605327
Provider Name (Legal Business Name): LYNDZEE TILLEY CRC, LCMHC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 HAMMOND BUSINESS PL STE 101
RALEIGH NC
27603-3666
US

IV. Provider business mailing address

70 MOSSYCUP LOOP APT 203
GARNER NC
27529-4195
US

V. Phone/Fax

Practice location:
  • Phone: 919-664-1233
  • Fax:
Mailing address:
  • Phone: 919-972-1894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number630969
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA21578
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: