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Individual

MIRIAM REISHUN LYDE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCMHC,LCAS-P

Contact information

Practice address
820 GRIMES BLVD, LEXINGTON, NC 27292-7640
(336) 224-6071
(336) 224-6393
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(336) 718-3550
(336) 277-6981

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
101YP2500X
Professional Counselor
LPCA11494
NC

Other

Enumeration date
07/11/2012
Last updated
07/22/2020
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