MEDICARE: MS. LYNDA WOODBURN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578538369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYNDA WOODBURN

Provider Business Mailing Address
First Line	:	9201 WESTBURY WOODS DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-3585
Country	:	US
Telephone Number	:	704-540-7183
Fax Number	:

Provider Business Practice Location Address
First Line	:	5007 PROVIDENCE RD
Second Line	:	#105
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-5849
Country	:	US
Telephone Number	:	704-364-6594
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	07/08/2007

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Directions to “ MS. LYNDA WOODBURN ” Practice Location

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