Healthcare Provider Details

I. General information

NPI: 1962548677
Provider Name (Legal Business Name): DAYNA L SYKES LPC, MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 JMZ DR
GORDONSVILLE TN
38563-2106
US

IV. Provider business mailing address

PO BOX 305
GORDONSVILLE TN
38563-0305
US

V. Phone/Fax

Practice location:
  • Phone: 615-489-6675
  • Fax: 615-683-8955
Mailing address:
  • Phone: 615-489-6675
  • Fax: 615-683-8955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2641
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: