Provider Demographics
NPI:1114648482
Name:HYATT, LYNDA (PH D)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:HYATT
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 DICKENS RD STE 106
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1953
Mailing Address - Country:US
Mailing Address - Phone:804-767-0292
Mailing Address - Fax:804-269-5003
Practice Address - Street 1:4905 DICKENS RD STE 106
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1953
Practice Address - Country:US
Practice Address - Phone:804-767-0292
Practice Address - Fax:804-269-5003
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000206103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical