Healthcare Provider Details

I. General information

NPI: 1225208713
Provider Name (Legal Business Name): LYNN STROLE CCSW LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2517 CAUDLE MILL RD
YADKINVILLE NC
27055-5109
US

IV. Provider business mailing address

2517 CAUDLE MILL RD
YADKINVILLE NC
27055-5109
US

V. Phone/Fax

Practice location:
  • Phone: 336-659-9440
  • Fax: 336-659-9845
Mailing address:
  • Phone: 336-659-9440
  • Fax: 336-659-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC002408
License Number StateNC

VIII. Authorized Official

Name: LYNN STROLE
Title or Position: OWNER
Credential: CCSW
Phone: 336-659-9440