Lynetta Davies
Individual provider Active NPI Counselor · Eastmon, GA
NPI 1174832232 · NPPES record last updated Oct 6, 2010
Key facts
- NPI
- 1174832232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- LPC006087 (GA)
- Practice address
- 17 Tanner Dr
Eastmon, GA 31023 - Phone
- (478) 285-0001
- NPI assigned
- Oct 6, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC006087 | GA | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | LPC006087 | GA | Yes |
Addresses
Primary practice location
17 Tanner Dr
Eastmon, GA 31023
Mailing address
17 Tanner Dr
Eastmon, GA 31023
Phone (478) 285-0001
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.