Provider Demographics
NPI:1376861617
Name:AGUIAR, LYNDON J (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNDON
Middle Name:J
Last Name:AGUIAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 SANDSTONE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-6300
Mailing Address - Country:US
Mailing Address - Phone:804-639-5695
Mailing Address - Fax:
Practice Address - Street 1:10515 CABANISS LN
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:VA
Practice Address - Zip Code:23069-1840
Practice Address - Country:US
Practice Address - Phone:804-559-9959
Practice Address - Fax:888-464-1257
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004342103TC0700X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical