Healthcare Provider Details

I. General information

NPI: 1134460884
Provider Name (Legal Business Name): LYNN LOUISE BURKE REYES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYNN LOUISE BURKE

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 WEST AVE
NORTH AUGUSTA SC
29841-3312
US

IV. Provider business mailing address

1007 WEST AVE
NORTH AUGUSTA SC
29841-3312
US

V. Phone/Fax

Practice location:
  • Phone: 706-503-8216
  • Fax:
Mailing address:
  • Phone: 706-503-8216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC006381
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8853
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLPC006381
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8853
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: