Provider Demographics
NPI:1083598734
Name:LYONS, NADINE AMANDA (LGPC)
Entity type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:AMANDA
Last Name:LYONS
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21914 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-3475
Mailing Address - Country:US
Mailing Address - Phone:240-640-9499
Mailing Address - Fax:
Practice Address - Street 1:210 ABRECHT PL
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4918
Practice Address - Country:US
Practice Address - Phone:301-662-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP16093101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor