Basic Information
| Provider Information | |||||||||
| NPI: | 1619068905 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCBRIDE | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LPC, LMFT,CSAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 134 ELON RD | ||||||||
| Address2: | |||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245722536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4344552480 | ||||||||
| FaxNumber: | 4344552487 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 FEDERAL ST | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245042306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349475967 | ||||||||
| FaxNumber: | 4349475971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 04/02/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 0710000995 | VA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 0701002425 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | 0717000590 | VA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 004945441 | 05 | VA | MEDICAID | 331950 | 01 | VA | ANTHEM BLUE SHIELD | OTHER | O88267 | 01 | VA | SENTARA | OTHER |