Provider Demographics
NPI:1881836823
Name:BLACK, LYNDA (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 S COLLEGIATE DR
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-2102
Mailing Address - Country:US
Mailing Address - Phone:336-838-6148
Mailing Address - Fax:
Practice Address - Street 1:1328 S COLLEGIATE DR
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2102
Practice Address - Country:US
Practice Address - Phone:336-838-6148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2313101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional