MEDICARE: LYNN HENDRICK CARLSON LCMHCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	A20386	NC

General Provider Information

NPI Number	:	1710704390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN HENDRICK CARLSON LCMHCA

Provider Business Mailing Address
First Line	:	5701 PRESTON LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-5255
Country	:	US
Telephone Number	:	704-296-8091
Fax Number	:

Provider Business Practice Location Address
First Line	:	5641 PRESTON LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-5253
Country	:	US
Telephone Number	:	704-296-8091
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2024
Last Update Date	:	09/24/2024

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