Individual
PENNY GAYLE LILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-A, CRC
Contact information
Practice address
4140 CHERRY ST, WINSTON SALEM, NC 27105-2536
(336) 448-2737
(336) 306-9629
Mailing address
4140 N. CHERRY STREET, WINSTON SALEM, NC 27105
(336) 448-2737
(336) 306-9629
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
A11493
NC
Other
Enumeration date
05/11/2015
Last updated
05/11/2015
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