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General NPI Number Information
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NPI Number | 1467881862
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Entity Type | Individual
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Provider Name | VIVIAN LYLES
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Gender | Female
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Dates
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Enumeration Date | 11/06/2013
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 908 20TH ST S FL 4
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City | BIRMINGHAM
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State | AL
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Zip | 35205-2610
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Country | US
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Telephone | 205-996-2697
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 55310
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City | BIRMINGHAM
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State | AL
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Zip | 35255-5310
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Country | US
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Telephone | 205-731-9701
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3309G
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3915C
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License Number State | AL
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