Healthcare Provider Details

I. General information

NPI: 1083598734
Provider Name (Legal Business Name): NADINE AMANDA LYONS LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 ABRECHT PL
FREDERICK MD
21701-4918
US

IV. Provider business mailing address

21914 BROADWAY AVE
CLARKSBURG MD
20871-3475
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-3223
  • Fax:
Mailing address:
  • Phone: 240-640-9499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP16093
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: