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General NPI Number Information
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NPI Number | 1851773121
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Entity Type | Organization
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Legal Business Name | LYDIA KICKLITER, LPC, LLC
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 10/12/2017
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Provider Practice Location Address
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Address Line | 29 RAVENSCROFT DR STE 102
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City | ASHEVILLE
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State | NC
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Zip | 28801-3655
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Country | US
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Telephone | 727-643-5594
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Fax | 855-355-4064
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Provider Business Mailing Address
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Address Line | 29 RAVENSCROFT DR STE 102
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City | ASHEVILLE
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State | NC
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Zip | 28801-3655
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Country | US
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Telephone | 727-643-5594
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Fax | 855-355-4064
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | LYDIA KICKLITER
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Credential | LMHC
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Telephone | 727-643-5594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 12763
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License Number State | NC
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