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Organization

LILYCO SERVICES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
YOLANDO OXENDINE (CHIEF EXECUTIVE OFFICER)
(919) 395-8032
Entity
Organization

Contact information

Practice address
112 W WINDER ST, HENDERSON, NC 27536-4239
(919) 395-8032
(919) 395-8032
Mailing address
7004 SPANGLERS SPRING WAY, RALEIGH, NC 27610-5271
(919) 395-8032

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
101YA0400X
Addiction (Substance Use Disorder) Counselor
101YM0800X
Mental Health Counselor
103TA0400X
Addiction (Substance Use Disorder) Psychologist
1041C0700X
Clinical Social Worker
171M00000X
Case Manager/Care Coordinator
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
2084P0800X
Psychiatry Physician
251S00000X
Community/Behavioral Health Agency
Primary
363LP0808X
Psychiatric/Mental Health Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1588641880
NC
05
1861730095
NC
Enumeration date
07/14/2017
Last updated
08/21/2025
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