Provider Demographics
NPI:1558423616
Name:SMITH, LYNN Q (EDS)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:Q
Last Name:SMITH
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 SUMTER ST
Mailing Address - Street 2:PASTORAL COUNSELING CENTER
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2829
Mailing Address - Country:US
Mailing Address - Phone:803-296-5879
Mailing Address - Fax:803-296-5061
Practice Address - Street 1:1501 SUMTER ST
Practice Address - Street 2:PASTORAL COUNSELING CENTER
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2829
Practice Address - Country:US
Practice Address - Phone:803-296-5879
Practice Address - Fax:803-296-5061
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional