Healthcare Provider Details

I. General information

NPI: 1124783147
Provider Name (Legal Business Name): LYNSEY JOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 SHILOH RD NW STE 2160
KENNESAW GA
30144-7185
US

IV. Provider business mailing address

1960 SPECTRUM CIR SE APT 605
MARIETTA GA
30067-6090
US

V. Phone/Fax

Practice location:
  • Phone: 956-440-4530
  • Fax:
Mailing address:
  • Phone: 678-591-1356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: