=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225208713
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LYNN STROLE CCSW LCSW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2008
-----------------------------------------------------
Last Update Date | 03/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2517 CAUDLE MILL RD
-----------------------------------------------------
City | YADKINVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27055-5109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-659-9440
-----------------------------------------------------
Fax | 336-659-9845
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2517 CAUDLE MILL RD
-----------------------------------------------------
City | YADKINVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27055-5109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-659-9440
-----------------------------------------------------
Fax | 336-659-9845
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LYNN STROLE
-----------------------------------------------------
Credential | CCSW
-----------------------------------------------------
Telephone | 336-659-9440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C002408
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------