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General NPI Number Information
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NPI Number | 1265647358
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Entity Type | Individual
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Provider Name | LAVONNE ANNETTE LYNCH PHD., MAC, CCJS, LPC
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 220 S RIDGEWOOD AVE SUITE 260
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4318
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Country | US
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Telephone | 386-566-5138
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Fax |
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Provider Business Mailing Address
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Address Line | 5077 ORANGE AVE
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City | PORT ORANGE
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State | FL
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Zip | 32127-5417
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Country | US
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Telephone | 386-690-8278
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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