Provider Demographics
NPI:1477331957
Name:GAMMONS, LYNDSEY PAIGE
Entity Type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:PAIGE
Last Name:GAMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1104
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-8104
Mailing Address - Country:US
Mailing Address - Phone:540-488-5636
Mailing Address - Fax:
Practice Address - Street 1:370 TANYARD RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1554
Practice Address - Country:US
Practice Address - Phone:540-488-5636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0734009971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health