Organization
ENGAGED N PURPOSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FONDA ALTHEA LYLES LCSW (FOUNDER/CEO)
(757) 537-2919
Entity
Organization
Contact information
Practice address
4400 BRUCE FARM DR, SUFFOLK, VA 23435-1255
(757) 537-2919
Mailing address
PO BOX 5012, SUFFOLK, VA 23435-0012
(757) 537-2919
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/05/2023
Last updated
06/05/2023
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