Provider Demographics
NPI:1801025002
Name:SHAMP, LINDSEY MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:MICHELLE
Last Name:SHAMP
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LINDSEY
Other - Middle Name:MICHELLE
Other - Last Name:ROBERGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-0086
Mailing Address - Country:US
Mailing Address - Phone:619-519-6957
Mailing Address - Fax:
Practice Address - Street 1:9375 WESTHILL RD
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:CA
Practice Address - Zip Code:92040-3636
Practice Address - Country:US
Practice Address - Phone:619-519-6957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)