Healthcare Provider Details

I. General information

NPI: 1093790784
Provider Name (Legal Business Name): LORELEI E. LINDOW MA, NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 HILLSBOROUGH ST
RALEIGH NC
27605-1828
US

IV. Provider business mailing address

2327 LYON ST
RALEIGH NC
27608-2013
US

V. Phone/Fax

Practice location:
  • Phone: 919-706-5609
  • Fax:
Mailing address:
  • Phone: 704-953-1328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3783
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: