Provider Demographics
NPI:1922121904
Name:GLASS, LYNESSA (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:LYNESSA
Middle Name:
Last Name:GLASS
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4356 BONNEY RD
Mailing Address - Street 2:BUILDING 1, STE 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1200
Mailing Address - Country:US
Mailing Address - Phone:757-717-0605
Mailing Address - Fax:757-498-3311
Practice Address - Street 1:4356 BONNEY RD
Practice Address - Street 2:BUILDING 1, STE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1200
Practice Address - Country:US
Practice Address - Phone:757-717-0605
Practice Address - Fax:757-498-3311
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002709101YP2500X
VA0717000634106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist