Healthcare Provider Details

I. General information

NPI: 1831920305
Provider Name (Legal Business Name): LINDSEY COLVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 CORPORATE CENTER DR STE B
STOCKBRIDGE GA
30281-7214
US

IV. Provider business mailing address

1250 GROVE PKWY
JONESBORO GA
30236-3249
US

V. Phone/Fax

Practice location:
  • Phone: 770-728-3990
  • Fax:
Mailing address:
  • Phone: 404-632-4522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: