Provider Demographics
NPI:1003633827
Name:LINDY, MARK W (PASTORAL COUNSELOR)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:W
Last Name:LINDY
Suffix:
Gender:M
Credentials:PASTORAL COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 MEMORIAL AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2620
Mailing Address - Country:US
Mailing Address - Phone:434-584-8058
Mailing Address - Fax:
Practice Address - Street 1:2420 MEMORIAL AVE STE 301
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2620
Practice Address - Country:US
Practice Address - Phone:434-584-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23800101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral