Individual
LYDIAELISEE PHILOGENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8505 KENBROOKE DR APT 1402, CHARLOTTE, NC 28262-5633
(304) 894-5987
Mailing address
8505 KENBROOKE DR APT 1402, CHARLOTTE, NC 28262-5633
(304) 894-5987
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A23216
NC
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
12/28/2021
Last updated
08/05/2026
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