Healthcare Provider Details

I. General information

NPI: 1366675647
Provider Name (Legal Business Name): LYNDA PHILLIPS EVANS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5821 STAPLES MILL RD
RICHMOND VA
23228-5427
US

IV. Provider business mailing address

8911 SIERRA RD
RICHMOND VA
23229-7828
US

V. Phone/Fax

Practice location:
  • Phone: 804-264-0966
  • Fax: 804-264-1012
Mailing address:
  • Phone: 804-543-0541
  • Fax: 804-264-1029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701002530
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: