Provider Demographics
NPI:1629171236
Name:ZOLL, LYNN A (PSY D)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:A
Last Name:ZOLL
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:A
Other - Last Name:ROUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSY D
Mailing Address - Street 1:303 34TH ST STE 7
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-2855
Mailing Address - Country:US
Mailing Address - Phone:757-636-1229
Mailing Address - Fax:757-425-9020
Practice Address - Street 1:303 34TH ST
Practice Address - Street 2:STE 7
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-2855
Practice Address - Country:US
Practice Address - Phone:757-425-5050
Practice Address - Fax:757-425-1389
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0801000686103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007728492Medicaid