Provider Demographics
NPI:1932200128
Name:BEATTY, LYNDA S (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:S
Last Name:BEATTY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:S
Other - Last Name:BEATTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:150 OLDE GREENWICH DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4063
Mailing Address - Country:US
Mailing Address - Phone:540-898-6851
Mailing Address - Fax:
Practice Address - Street 1:150 OLDE GREENWICH DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4063
Practice Address - Country:US
Practice Address - Phone:540-898-6851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002237101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA65340002OtherCARE FIRST BC/BS
VA122456OtherVALUE OPTIONS
VA2228075OtherCIGNA
VA363052OtherMAMSI
VA086127OtherSENTARA
VA5409730Medicaid
VA214992OtherBC/BS