Healthcare Provider Details

I. General information

NPI: 1780792325
Provider Name (Legal Business Name): LYNDIS FAYE ANDERSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 HERRINGTON RD BLDG 2
LAWRENCEVILLE GA
30043-5649
US

IV. Provider business mailing address

1805 HERRINGTON RD BLDG 2
LAWRENCEVILLE GA
30043-5649
US

V. Phone/Fax

Practice location:
  • Phone: 770-962-1944
  • Fax: 770-962-1886
Mailing address:
  • Phone: 770-962-1944
  • Fax: 770-962-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number001676
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: