Provider Demographics
NPI:1083832653
Name:LYON, NICOL LYNN (MS, CSC-AD)
Entity Type:Individual
Prefix:MRS
First Name:NICOL
Middle Name:LYNN
Last Name:LYON
Suffix:
Gender:F
Credentials:MS, CSC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-6045
Mailing Address - Country:US
Mailing Address - Phone:301-687-0940
Mailing Address - Fax:301-687-0948
Practice Address - Street 1:14701 NATIONAL HWY SW
Practice Address - Street 2:SUITES 5 & 6
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-6573
Practice Address - Country:US
Practice Address - Phone:301-687-0940
Practice Address - Fax:301-687-0948
Is Sole Proprietor?:No
Enumeration Date:2007-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD007343101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)