Healthcare Provider Details

I. General information

NPI: 1790460780
Provider Name (Legal Business Name): KAITLYNNE ROSE LYNCH LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W SUMTER ST
SHELBY NC
28150-4326
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-476-8399
  • Fax: 704-476-8316
Mailing address:
  • Phone: 704-874-1904
  • Fax: 704-865-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP019101
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: