Provider Demographics
NPI:1851435051
Name:BEATTIE, LYNN T
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:T
Last Name:BEATTIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 26
Mailing Address - Street 2:
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376-0026
Mailing Address - Country:US
Mailing Address - Phone:910-673-6226
Mailing Address - Fax:910-673-6226
Practice Address - Street 1:1138 SEVEN LAKES NORTH
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376-0026
Practice Address - Country:US
Practice Address - Phone:910-673-6226
Practice Address - Fax:910-673-6226
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102480Medicaid