Provider Demographics
NPI:1689956377
Name:YATES, LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 SHARON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4721
Mailing Address - Country:US
Mailing Address - Phone:704-554-9900
Mailing Address - Fax:
Practice Address - Street 1:8211 VILLAGE HARBOR DR
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-3706
Practice Address - Country:US
Practice Address - Phone:704-860-0928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL47661041C0700X
NCC0077101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical