Healthcare Provider Details

I. General information

NPI: 1316347305
Provider Name (Legal Business Name): CORWYNN SYLVESTER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 DAWSONVILLE HWY SUITE 2201
GAINESVILLE GA
30501-2610
US

IV. Provider business mailing address

3311 LEEDS WAY
DULUTH GA
30096-3648
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-9100
  • Fax: 770-534-9104
Mailing address:
  • Phone: 770-534-9100
  • Fax: 770-534-9104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC007814
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: