Provider Demographics
NPI:1760565246
Name:BYNNOM, PAULA WINEBARGER (LCAS)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:WINEBARGER
Last Name:BYNNOM
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 CHARLOTTE RD
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-2916
Mailing Address - Country:US
Mailing Address - Phone:828-288-8773
Mailing Address - Fax:828-287-7946
Practice Address - Street 1:356 CHARLOTTE RD
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2916
Practice Address - Country:US
Practice Address - Phone:828-288-8773
Practice Address - Fax:828-287-7946
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC809101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111910Medicaid