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General NPI Number Information
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NPI Number | 1417495474
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH & SPIRITUAL WELLNESS THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 213-D S TRADE STREET
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City | SHELBY
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State | NC
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Zip | 28150-4866
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Country | US
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Telephone | 704-231-9025
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Fax |
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Provider Business Mailing Address
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Address Line | 213-D SOUTH TRADE STREET
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City | SHELBY
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State | NC
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Zip | 28150-4564
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Country | US
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Telephone | 704-231-9025
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Fax |
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Authorized Official
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Title or Position | OWNER/ PSYCHOTHERAPIST
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Name | DR. TYNECCA GAIL LYNCH
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Credential | PHD, LCSW
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Telephone | 704-231-9025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C006811
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License Number State | NC
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