Provider Demographics
NPI:1710186622
Name:CUSTER, BILLIE LYNNE (LCPC)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:LYNNE
Last Name:CUSTER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7095 GENE WAYNE LN
Mailing Address - Street 2:
Mailing Address - City:NEW CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:23415-2421
Mailing Address - Country:US
Mailing Address - Phone:757-824-9844
Mailing Address - Fax:
Practice Address - Street 1:WORCESTER COUNTY HEALTH DEPARTMENT
Practice Address - Street 2:6040 PUBLIC LANDING ROAD
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863
Practice Address - Country:US
Practice Address - Phone:410-632-1100
Practice Address - Fax:410-632-0906
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2420101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS013Medicare UPIN