Provider Demographics
NPI:1093334708
Name:LYNCH, OLIVIA SHIPP
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:SHIPP
Last Name:LYNCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 CENTERVIEW DR STE 204
Mailing Address - Street 2:PMB 285102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-8012
Mailing Address - Country:US
Mailing Address - Phone:910-236-6848
Mailing Address - Fax:
Practice Address - Street 1:738 CEDAR LAKE LN
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-8792
Practice Address - Country:US
Practice Address - Phone:910-236-6848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6192103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist