Provider Demographics
NPI:1750612214
Name:LEOPARD, LYNNIE (MRC, CRC, CACII, LPC)
Entity type:Individual
Prefix:MS
First Name:LYNNIE
Middle Name:
Last Name:LEOPARD
Suffix:
Gender:F
Credentials:MRC, CRC, CACII, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 WHIPPOORWILL DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4745
Mailing Address - Country:US
Mailing Address - Phone:803-312-2752
Mailing Address - Fax:
Practice Address - Street 1:1415 BLANDING ST
Practice Address - Street 2:SUITE 4
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2922
Practice Address - Country:US
Practice Address - Phone:803-779-7500
Practice Address - Fax:803-779-7522
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-23
Last Update Date:2013-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5082101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional