Provider Demographics
NPI:1801090378
Name:OLSEFSKI, LYNN M (LCSW)
Entity type:Individual
Prefix:MISS
First Name:LYNN
Middle Name:M
Last Name:OLSEFSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 HARRELL ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27855-1818
Mailing Address - Country:US
Mailing Address - Phone:252-370-4885
Mailing Address - Fax:
Practice Address - Street 1:1321 1ST ST W
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-8842
Practice Address - Country:US
Practice Address - Phone:252-209-8932
Practice Address - Fax:252-209-8933
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040065831041C0700X
NCC0067011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA014226N05Medicare PIN