Healthcare Provider Details

I. General information

NPI: 1134460884
Provider Name (Legal Business Name): LYNN LOUISE BURKE REYES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYNN LOUISE BURKE

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 RIDGEVIEW DR
AUGUSTA GA
30909-9641
US

IV. Provider business mailing address

2803 RIDGEVIEW DR
AUGUSTA GA
30909-9641
US

V. Phone/Fax

Practice location:
  • Phone: 706-650-7707
  • Fax:
Mailing address:
  • Phone: 706-650-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLPC006381
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLPC006381
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC006381
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: