Provider Demographics
NPI:1295350338
Name:EARLYWINE, LUCINDA ANN I
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:ANN
Last Name:EARLYWINE
Suffix:I
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 1:1661 BALTIMORE DR APT D
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-6613
Mailing Address - Country:US
Mailing Address - Phone:765-977-0458
Mailing Address - Fax:
Practice Address - Street 1:1661 BALTIMORE DR APT D
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-6613
Practice Address - Country:US
Practice Address - Phone:765-977-0458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor