MEDICARE: LYNN LOUISE WONDERS M.A., LPC, RYT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC004848	GA

General Provider Information

NPI Number	:	1861668113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN LOUISE WONDERS M.A., LPC, RYT

Provider Business Mailing Address
First Line	:	2440 SANDY PLAINS RD
Second Line	:	BLDG. 13 SUITE 300
City	:	MARIETTA
State	:	GA
Zip	:	30066-7217
Country	:	US
Telephone Number	:	770-971-9311
Fax Number	:

Provider Business Practice Location Address
First Line	:	2440 SANDY PLAINS RD
Second Line	:	BLDG. 13 SUITE 300
City	:	MARIETTA
State	:	GA
Zip	:	30066-7217
Country	:	US
Telephone Number	:	770-971-9311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	05/07/2008

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