Provider Demographics
NPI:1023443744
Name:SARNELL, LONNIE BRYCE
Entity type:Individual
Prefix:
First Name:LONNIE
Middle Name:BRYCE
Last Name:SARNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7313 CATESWOOD CT
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-9387
Mailing Address - Country:US
Mailing Address - Phone:973-615-3512
Mailing Address - Fax:
Practice Address - Street 1:7313 CATESWOOD CT
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-9387
Practice Address - Country:US
Practice Address - Phone:973-615-3512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019859103TC0700X
NY020141103TC0700X
NJ35SI00545000103TC0700X
NC6328103TE1100X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports