Provider Demographics
NPI:1477266401
Name:AMBURN, LINDSAY MOORE (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:MOORE
Last Name:AMBURN
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1376 MUDDY FORD RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE MOUNTAIN
Mailing Address - State:SC
Mailing Address - Zip Code:29075-9652
Mailing Address - Country:US
Mailing Address - Phone:803-238-4394
Mailing Address - Fax:
Practice Address - Street 1:1376 MUDDY FORD RD
Practice Address - Street 2:
Practice Address - City:LITTLE MOUNTAIN
Practice Address - State:SC
Practice Address - Zip Code:29075-9652
Practice Address - Country:US
Practice Address - Phone:803-238-4394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health