Provider Demographics
NPI:1578207643
Name:WOMBLE, LYNESHA (LPC)
Entity type:Individual
Prefix:
First Name:LYNESHA
Middle Name:
Last Name:WOMBLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S MILITARY HWY APT 1328
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-1886
Mailing Address - Country:US
Mailing Address - Phone:434-483-1081
Mailing Address - Fax:
Practice Address - Street 1:400 S MILITARY HWY APT 1328
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-1886
Practice Address - Country:US
Practice Address - Phone:434-483-1081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
VA0701013225101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No374J00000XNursing Service Related ProvidersDoula