Healthcare Provider Details

I. General information

NPI: 1427455211
Provider Name (Legal Business Name): LYNETTE WHITNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2014
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8134 OLD KEENE MILL RD
SPRINGFIELD VA
22152-1800
US

IV. Provider business mailing address

8134 OLD KEENE MILL RD
SPRINGFIELD VA
22152-1800
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-8731
  • Fax: 703-569-7248
Mailing address:
  • Phone: 703-569-8731
  • Fax: 703-569-7248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY31051
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPSB94023440
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810006344
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: