Provider Demographics
NPI:1306394358
Name:BANEZ, LYNN (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:BANEZ
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 GEORGE WASHINGTON MEM HWY STE F1
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-3350
Mailing Address - Country:US
Mailing Address - Phone:757-204-1866
Mailing Address - Fax:757-782-4004
Practice Address - Street 1:3630 GEORGE WASHINGTON MEM HWY STE F1
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-3350
Practice Address - Country:US
Practice Address - Phone:757-204-1866
Practice Address - Fax:757-782-4004
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005523101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1306394358Medicaid