Healthcare Provider Details

I. General information

NPI: 1689262412
Provider Name (Legal Business Name): AVADAWN LINDSAY PHD, LPC, CPCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 04/10/2021
Certification Date: 04/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 GUM CREEK CHURCH RD
LOGANVILLE GA
30052-4221
US

IV. Provider business mailing address

2210 GUM CREEK CHURCH RD
LOGANVILLE GA
30052-4221
US

V. Phone/Fax

Practice location:
  • Phone: 678-517-0271
  • Fax:
Mailing address:
  • Phone: 678-517-0271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC009466
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: