Provider Demographics
NPI:1639574056
Name:LYDY, GWENDOLYN WENDY (LPC-CR)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:WENDY
Last Name:LYDY
Suffix:
Gender:F
Credentials:LPC-CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 NORTHWOODS BLVD
Mailing Address - Street 2:SUITE A2
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4728
Mailing Address - Country:US
Mailing Address - Phone:614-905-7618
Mailing Address - Fax:
Practice Address - Street 1:1259 STATE ROUTE 203
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-9759
Practice Address - Country:US
Practice Address - Phone:740-815-7523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0700124101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional