Healthcare Provider Details

I. General information

NPI: 1871188128
Provider Name (Legal Business Name): LYDIA WORLEY WARREN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 HORSE SHOE BND
TRENT WOODS NC
28562-6615
US

IV. Provider business mailing address

2015 HORSE SHOE BND
TRENT WOODS NC
28562-6615
US

V. Phone/Fax

Practice location:
  • Phone: 252-671-6115
  • Fax:
Mailing address:
  • Phone: 252-671-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number718
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: