Healthcare Provider Details

I. General information

NPI: 1912811993
Provider Name (Legal Business Name): LYNDON CARR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11138 STATE BRIDGE RD # 100A
JOHNS CREEK GA
30022-7465
US

IV. Provider business mailing address

11138 STATE BRIDGE RD # 100A
JOHNS CREEK GA
30022-7465
US

V. Phone/Fax

Practice location:
  • Phone: 866-935-4333
  • Fax:
Mailing address:
  • Phone: 866-935-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC010270
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: