Basic Information
Provider Information
NPI: 1689813198
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PRESTI
FirstName: LINDSEY
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: LCPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1012
Address2:  
City: SEVERNA PARK
State: MD
PostalCode: 211468012
CountryCode: US
TelephoneNumber: 4109750067
FaxNumber:  
Practice Location
Address1: 570H RITCHIE HWY
Address2:  
City: SEVERNA PARK
State: MD
PostalCode: 211462925
CountryCode: US
TelephoneNumber: 4109750067
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/09/2009
LastUpdateDate: 07/07/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XLC2858MDY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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