Provider Demographics
NPI:1437021078
Name:FAMBRO, LIN MARTISH (LCAS-A)
Entity type:Individual
Prefix:
First Name:LIN
Middle Name:MARTISH
Last Name:FAMBRO
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9930 SEASON GROVE LN APT 207
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-6623
Mailing Address - Country:US
Mailing Address - Phone:980-285-2990
Mailing Address - Fax:704-842-3754
Practice Address - Street 1:1455 E FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4059
Practice Address - Country:US
Practice Address - Phone:980-285-2990
Practice Address - Fax:704-842-3754
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty