Healthcare Provider Details

I. General information

NPI: 1427338532
Provider Name (Legal Business Name): TAWANNA KAY FRAZIER LUMPKINS PHD LMHC LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8158 JENKINS RD
WINSTON GA
30187-1367
US

IV. Provider business mailing address

8158 JENKINS RD
WINSTON GA
30187-1367
US

V. Phone/Fax

Practice location:
  • Phone: 678-640-0160
  • Fax:
Mailing address:
  • Phone: 678-640-0160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH14620
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: