Healthcare Provider Details

I. General information

NPI: 1528925344
Provider Name (Legal Business Name): LYNDASHIA S FARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DOWD CIR
PINEHURST NC
28374-7932
US

IV. Provider business mailing address

3091 STONE CARRIAGE CIR # 3091B
FAYETTEVILLE NC
28304-5533
US

V. Phone/Fax

Practice location:
  • Phone: 910-687-6405
  • Fax:
Mailing address:
  • Phone: 502-259-8890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: