Provider Demographics
NPI:1730391814
Name:SZYMANDERA, MARY LYNN (LCAS)
Entity type:Individual
Prefix:MRS
First Name:MARY LYNN
Middle Name:
Last Name:SZYMANDERA
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 HENRY RUFF RD
Mailing Address - Street 2:
Mailing Address - City:MILL SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:28756-5806
Mailing Address - Country:US
Mailing Address - Phone:828-625-0337
Mailing Address - Fax:828-625-0337
Practice Address - Street 1:801 W MILLS ST STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-8495
Practice Address - Country:US
Practice Address - Phone:828-894-0293
Practice Address - Fax:828-894-0293
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC783101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)