Healthcare Provider Details

I. General information

NPI: 1962612614
Provider Name (Legal Business Name): LYNETTE V. FARR, PH.D., LMFT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 HOSPITAL DR SUITE 7-G
STOCKBRIDGE GA
30281-6393
US

IV. Provider business mailing address

1129 HOSPITAL DR SUITE 7-G
STOCKBRIDGE GA
30281-6393
US

V. Phone/Fax

Practice location:
  • Phone: 770-507-4124
  • Fax: 770-507-4124
Mailing address:
  • Phone: 770-507-4124
  • Fax: 770-507-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberMFT000296
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberMFT000296
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT000296
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberMFT000296
License Number StateGA

VIII. Authorized Official

Name: DR. LYNETTE VIRGINIA FARR
Title or Position: OWNER
Credential: PH.D., LMFT
Phone: 770-507-4124