Healthcare Provider Details

I. General information

NPI: 1790514487
Provider Name (Legal Business Name): LAKYN FRYE MSW, LCAS, LCSW-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/30/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 TROY DR
WILMINGTON NC
28401-7643
US

IV. Provider business mailing address

1625 S 17TH ST APT 365
WILMINGTON NC
28401-6573
US

V. Phone/Fax

Practice location:
  • Phone: 910-762-2727
  • Fax:
Mailing address:
  • Phone: 757-969-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-28895
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP019859
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: