Provider Demographics
NPI:1265647358
Name:LYNCH, LAVONNE ANNETTE (PHD, MAC, CCJS, LPC)
Entity Type:Individual
Prefix:DR
First Name:LAVONNE
Middle Name:ANNETTE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PHD, MAC, CCJS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5077 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-5417
Mailing Address - Country:US
Mailing Address - Phone:386-690-8278
Mailing Address - Fax:
Practice Address - Street 1:220 S RIDGEWOOD AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4318
Practice Address - Country:US
Practice Address - Phone:386-566-5138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator