Healthcare Provider Details

I. General information

NPI: 1245979913
Provider Name (Legal Business Name): JESSICA LYKES LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 WOOSTER RD
SOUTHERN PINES NC
28387-2354
US

IV. Provider business mailing address

185 WOOSTER RD
SOUTHERN PINES NC
28387-2354
US

V. Phone/Fax

Practice location:
  • Phone: 910-585-9074
  • Fax: 910-216-2504
Mailing address:
  • Phone: 910-585-9074
  • Fax: 910-216-2504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17552
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: