Provider Demographics
NPI:1679697528
Name:LYNCH, BEVERLY HOLSTUN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:HOLSTUN
Last Name:LYNCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BEVERLY
Other - Middle Name:HOLSTUN
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6313 MORI ST
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3153
Mailing Address - Country:US
Mailing Address - Phone:703-556-9509
Mailing Address - Fax:703-556-9528
Practice Address - Street 1:6313 MORI ST
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3153
Practice Address - Country:US
Practice Address - Phone:703-556-9509
Practice Address - Fax:703-556-9528
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040006561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical