Provider Demographics
NPI:1639847908
Name:LINCOLN, VIRGINIA WOLLRICH (LMFT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:WOLLRICH
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11711 BABBITT AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-2438
Mailing Address - Country:US
Mailing Address - Phone:818-383-2727
Mailing Address - Fax:
Practice Address - Street 1:15545 DEVONSHIRE ST STE 208
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2638
Practice Address - Country:US
Practice Address - Phone:818-383-2727
Practice Address - Fax:818-360-8558
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2891-R106H00000X
CA77749106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty