Provider Demographics
NPI:1972236560
Name:SAULS, LYDIA ALEXANDRA (MA, NCC, LCMHCA)
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:ALEXANDRA
Last Name:SAULS
Suffix:
Gender:F
Credentials:MA, NCC, LCMHCA
Other - Prefix:MS
Other - First Name:LYDIA
Other - Middle Name:ALEXANDRA
Other - Last Name:MONTEIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:515 GEORGETOWN DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-6463
Mailing Address - Country:US
Mailing Address - Phone:954-816-2479
Mailing Address - Fax:
Practice Address - Street 1:280 CONCORD PKWY S STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-2705
Practice Address - Country:US
Practice Address - Phone:980-209-6328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17774101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health