Provider Demographics
NPI:1679813612
Name:RAGLAND, LYNELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:LYNELLE
Middle Name:
Last Name:RAGLAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 STEEPLE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8976
Mailing Address - Country:US
Mailing Address - Phone:803-606-0564
Mailing Address - Fax:
Practice Address - Street 1:2611 RIVER DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-1749
Practice Address - Country:US
Practice Address - Phone:803-606-0564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1231103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist