Provider Demographics
NPI:1992768865
Name:LYON, DIANE REID (MA, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:REID
Last Name:LYON
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5416 SILVER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6761
Mailing Address - Country:US
Mailing Address - Phone:704-605-3096
Mailing Address - Fax:
Practice Address - Street 1:325 MATTHEWS MINT HILL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2816
Practice Address - Country:US
Practice Address - Phone:704-635-6274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2212101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1023ROtherBLUE CROSS BLUE SHIELD
NC6102906Medicaid