Provider Demographics
NPI:1265978456
Name:PIERSALL, LYNN EVANS
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:EVANS
Last Name:PIERSALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4928
Mailing Address - Country:US
Mailing Address - Phone:252-940-1611
Mailing Address - Fax:
Practice Address - Street 1:100 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4928
Practice Address - Country:US
Practice Address - Phone:252-940-1611
Practice Address - Fax:252-940-1752
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0121071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical