Provider Demographics
NPI:1942411871
Name:LYNDA WOODBURN, MSW, LCSW
Entity Type:Organization
Organization Name:LYNDA WOODBURN, MSW, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:704-540-5566
Mailing Address - Street 1:3315 SPRINGBANK LN
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3197
Mailing Address - Country:US
Mailing Address - Phone:704-540-5566
Mailing Address - Fax:704-540-5664
Practice Address - Street 1:3315 SPRINGBANK LN
Practice Address - Street 2:SUITE 302
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3197
Practice Address - Country:US
Practice Address - Phone:704-540-5566
Practice Address - Fax:704-540-5664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0044591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC138MGOtherBLUE CROSS BLUE SHIELD