Provider Demographics
NPI:1700062973
Name:LYNCH-STANLEY, TOD A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TOD
Middle Name:A
Last Name:LYNCH-STANLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-6809
Mailing Address - Country:US
Mailing Address - Phone:912-261-1248
Mailing Address - Fax:515-474-0705
Practice Address - Street 1:1520 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-6809
Practice Address - Country:US
Practice Address - Phone:912-261-1248
Practice Address - Fax:515-474-0705
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0012791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1356564082OtherNPI - BUSINESS NAME