Provider Demographics
NPI:1104323187
Name:FRAYLON, TAYONA LANIA
Entity type:Individual
Prefix:
First Name:TAYONA
Middle Name:LANIA
Last Name:FRAYLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 TANK TOWN RD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-2757
Mailing Address - Country:US
Mailing Address - Phone:704-506-2566
Mailing Address - Fax:704-814-0323
Practice Address - Street 1:134 W MATTHEWS ST
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1305
Practice Address - Country:US
Practice Address - Phone:704-708-4605
Practice Address - Fax:704-469-5807
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13729101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health