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General NPI Number Information
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NPI Number | 1023158466
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Entity Type | Individual
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Provider Name | LYNETTE VIRGINIA FARR PH.D., LMFT
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Gender | Female
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 240 CORPORATE CENTER DR SUITE D
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7214
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Country | US
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Telephone | 770-507-4124
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Fax | 770-507-4124
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Provider Business Mailing Address
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Address Line | 240 CORPORATE CENTER DR SUITE D
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7214
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Country | US
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Telephone | 770-507-4124
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Fax | 770-507-4124
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | MFT000296
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | MFT000296
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | MFT000296
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT000296
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License Number State | GA
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