Provider Demographics
NPI:1508100090
Name:LYNCH, BRUCE A (LPC, NCAC, CAC II)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:A
Last Name:LYNCH
Suffix:
Gender:M
Credentials:LPC, NCAC, CAC II
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 2856
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29578-2856
Mailing Address - Country:US
Mailing Address - Phone:843-424-3485
Mailing Address - Fax:888-430-7476
Practice Address - Street 1:1018 16TH AVE NW
Practice Address - Street 2:SUITE #1
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-8269
Practice Address - Country:US
Practice Address - Phone:843-424-3485
Practice Address - Fax:888-430-7476
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5687101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional