Individual
MRS. FONDA ALTHEA LYLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4400 BRUCE FARM DR, SUFFOLK, VA 23435-1255
(757) 537-2919
Mailing address
4400 BRUCE FARM DR, SUFFOLK, VA 23435-1255
(757) 537-2919
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
0904008885
VA
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
06/06/2017
Last updated
05/24/2023
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