Provider Demographics
NPI:1861779589
Name:LANZY, LYNITRA ROCHELLE
Entity type:Individual
Prefix:
First Name:LYNITRA
Middle Name:ROCHELLE
Last Name:LANZY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNITRA
Other - Middle Name:ROCHELLE
Other - Last Name:AARON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2525
Mailing Address - Country:US
Mailing Address - Phone:510-839-3800
Mailing Address - Fax:510-839-3888
Practice Address - Street 1:111 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-2525
Practice Address - Country:US
Practice Address - Phone:510-839-3800
Practice Address - Fax:510-839-3888
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor