Provider Demographics
NPI:1427105261
Name:LYLE PROFESSIONAL CONSULTING, LLC
Entity type:Organization
Organization Name:LYLE PROFESSIONAL CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEENA
Authorized Official - Middle Name:ALTHEA
Authorized Official - Last Name:LYLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-745-2660
Mailing Address - Street 1:611 MOOREFIELD PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3667
Mailing Address - Country:US
Mailing Address - Phone:804-745-2660
Mailing Address - Fax:804-745-2644
Practice Address - Street 1:611 MOOREFIELD PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-3667
Practice Address - Country:US
Practice Address - Phone:804-745-2660
Practice Address - Fax:804-745-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA787251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010298482Medicaid