Provider Demographics
NPI:1518692409
Name:STOLLER, LINCOLN (PHD, CHT, CCPCPR)
Entity Type:Individual
Prefix:DR
First Name:LINCOLN
Middle Name:
Last Name:STOLLER
Suffix:
Gender:M
Credentials:PHD, CHT, CCPCPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:BRITISH COLUMBIA
Mailing Address - Zip Code:V8Z 5C8
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:81 HIGH STREET
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:BRITISH COLUMBIA
Practice Address - Zip Code:V8Z 5C8
Practice Address - Country:CA
Practice Address - Phone:250-885-8677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health