Healthcare Provider Details

I. General information

NPI: 1710927900
Provider Name (Legal Business Name): PATRICIA RAGLAND LYERLY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA IDA RAGLAND LCSW

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 MOCKSVILLE AVE
SALISBURY NC
28144-3328
US

IV. Provider business mailing address

314 MOCKSVILLE AVE
SALISBURY NC
28144-3328
US

V. Phone/Fax

Practice location:
  • Phone: 704-639-9973
  • Fax: 704-639-0869
Mailing address:
  • Phone: 704-639-9973
  • Fax: 704-639-0869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC002244
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: