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General NPI Number Information
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NPI Number | 1245581628
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Entity Type | Individual
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Provider Name | LYNDA JEANNE BIRCKHEAD PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 217 MCLAWS CIR SUITE 2
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-5855
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Country | US
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Telephone | 757-253-0371
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Fax |
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Provider Business Mailing Address
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Address Line | 1490 QUARTERPATH RD STE 5A-330
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-6544
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Country | US
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Telephone | 304-685-1588
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 396
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810004565
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License Number State | VA
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