Healthcare Provider Details

I. General information

NPI: 1720982028
Provider Name (Legal Business Name): CHARLES SCOTT LINDSTROM LPCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 REGENT PARK CT
GREENVILLE SC
29607-6547
US

IV. Provider business mailing address

18 FROSTY MEADOW CT
GREENVILLE SC
29615-4337
US

V. Phone/Fax

Practice location:
  • Phone: 864-630-6844
  • Fax:
Mailing address:
  • Phone: 864-630-6844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11222
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: