Provider Demographics
NPI:1396814687
Name:LEMMOND, TIMOTHY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:LEMMOND
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 S COLONIAL AVE
Mailing Address - Street 2:SUITE #300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1465
Mailing Address - Country:US
Mailing Address - Phone:704-332-3757
Mailing Address - Fax:704-335-8717
Practice Address - Street 1:118 S COLONIAL AVE
Practice Address - Street 2:SUITE #300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1465
Practice Address - Country:US
Practice Address - Phone:704-332-3757
Practice Address - Fax:704-335-8717
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4591101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102120Medicaid
NC1416TOtherBCBS OF NC PROVIDER ID