Provider Demographics
NPI:1558707604
Name:DAVIDSON, LYNNETTE JOY (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:JOY
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 7TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-2607
Mailing Address - Country:US
Mailing Address - Phone:615-498-1205
Mailing Address - Fax:
Practice Address - Street 1:1213 16TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2901
Practice Address - Country:US
Practice Address - Phone:615-498-1205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2859101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional