Healthcare Provider Details

I. General information

NPI: 1932655826
Provider Name (Legal Business Name): LYLA COLLECTIVE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S CHURCH ST SUITE 292
ROCKY MOUNT NC
27804-5755
US

IV. Provider business mailing address

301 S CHURCH ST SUITE 292
ROCKY MOUNT NC
27804-5755
US

V. Phone/Fax

Practice location:
  • Phone: 252-544-1817
  • Fax:
Mailing address:
  • Phone: 252-544-1817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: LAURYN E FRANCIS
Title or Position: EXECUTIVE DIRECTOR
Credential: M.ED, NCC, LPCA
Phone: 252-544-1817