Healthcare Provider Details

I. General information

NPI: 1144978867
Provider Name (Legal Business Name): CAITLIN K LYNCH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6136 ROXBURY AVE
WEST SPRINGFIELD VA
22152-1624
US

IV. Provider business mailing address

6136 ROXBURY AVE
WEST SPRINGFIELD VA
22152-1624
US

V. Phone/Fax

Practice location:
  • Phone: 919-946-7123
  • Fax:
Mailing address:
  • Phone: 919-946-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701011299
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: