MEDICARE: ANDREA RASHIKA LILES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	P012488	NC
2	1041C0700X	Clinical Social Worker	P012488	NC

General Provider Information

NPI Number	:	1619456712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA RASHIKA LILES

Provider Business Mailing Address
First Line	:	1 SILVERBROOK CT
Second Line	:
City	:	MC LEANSVILLE
State	:	NC
Zip	:	27301-9291
Country	:	US
Telephone Number	:	336-553-8371
Fax Number	:

Provider Business Practice Location Address
First Line	:	1073 BULLARD CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-6867
Country	:	US
Telephone Number	:	888-557-4080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2018
Last Update Date	:	10/08/2019

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