Healthcare Provider Details

I. General information

NPI: 1619032596
Provider Name (Legal Business Name): LYNN B BECK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 LAGRANGE ST SUITE C&D
NEWNAN GA
30263-2607
US

IV. Provider business mailing address

107 BEDFORD PARK DR
NEWNAN GA
30263
US

V. Phone/Fax

Practice location:
  • Phone: 404-431-5470
  • Fax:
Mailing address:
  • Phone: 404-431-5470
  • Fax: 770-253-8688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003729
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: