MEDICARE: LINDSEY UNDERWOOD LCSWA

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1578952917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY UNDERWOOD LCSWA

Provider Business Mailing Address
First Line	:	2231 E MILLBROOK RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-1746
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2231 E MILLBROOK RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-1746
Country	:	US
Telephone Number	:	919-307-8165
Fax Number	:	919-307-8167

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

Provider Enumeration Date	:	01/22/2015
Last Update Date	:	06/20/2016

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