Provider Demographics
NPI:1306226741
Name:FEDELE, LYNDI (LPC, CRC)
Entity Type:Individual
Prefix:
First Name:LYNDI
Middle Name:
Last Name:FEDELE
Suffix:
Gender:F
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 KRISTIANSAND DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-1013
Mailing Address - Country:US
Mailing Address - Phone:757-342-3783
Mailing Address - Fax:
Practice Address - Street 1:151 KRISTIANSAND DR
Practice Address - Street 2:SUITE 104
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-1013
Practice Address - Country:US
Practice Address - Phone:757-342-3783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00111342101Y00000X
VA0701006067101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor