Provider Demographics
NPI:1508328352
Name:WOLD, LINDSEY J (MA)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:J
Last Name:WOLD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:J
Other - Last Name:MCINTYRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:510 DEER TRACKS TRL
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-5908
Mailing Address - Country:US
Mailing Address - Phone:314-518-7967
Mailing Address - Fax:
Practice Address - Street 1:21 MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6359
Practice Address - Country:US
Practice Address - Phone:314-518-7967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health