Provider Demographics
NPI:1851572135
Name:GANNAWAY, LYNDA M (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:M
Last Name:GANNAWAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 EMERALD ACRES DR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-1104
Mailing Address - Country:US
Mailing Address - Phone:850-926-5439
Mailing Address - Fax:
Practice Address - Street 1:232 EMERALD ACRES DR
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-1104
Practice Address - Country:US
Practice Address - Phone:850-926-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW40261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical