Provider Demographics
NPI:1184005498
Name:LYNETTE CONSULTANTS
Entity Type:Organization
Organization Name:LYNETTE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALISTS
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-484-3879
Mailing Address - Street 1:2 RIVER CLUB CT
Mailing Address - Street 2:
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-4219
Mailing Address - Country:US
Mailing Address - Phone:843-987-2300
Mailing Address - Fax:843-987-3819
Practice Address - Street 1:2 RIVER CLUB CT
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-4219
Practice Address - Country:US
Practice Address - Phone:843-987-2300
Practice Address - Fax:843-987-3819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5782104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5782OtherSTATE LICENSE