Provider Demographics
NPI:1760462071
Name:LYNCH, JAMES MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:LYNCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:J
Other - Middle Name:MICHAEL
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:8140 ASHTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5698
Mailing Address - Country:US
Mailing Address - Phone:703-530-0979
Mailing Address - Fax:703-330-3966
Practice Address - Street 1:8140 ASHTON AVE
Practice Address - Street 2:STE 100
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5698
Practice Address - Country:US
Practice Address - Phone:703-530-0979
Practice Address - Fax:703-330-3966
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1365103T00000X
VA0810002823103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA680001515Medicare PIN