Healthcare Provider Details

I. General information

NPI: 1083023162
Provider Name (Legal Business Name): HEATHER LYNCH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CLAY DR
POUNDING MILL VA
24637-4320
US

IV. Provider business mailing address

220 CLAY DR
POUNDING MILL VA
24637-4320
US

V. Phone/Fax

Practice location:
  • Phone: 276-963-3606
  • Fax:
Mailing address:
  • Phone: 276-963-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004800
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: