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General NPI Number Information
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NPI Number | 1891863783
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Entity Type | Individual
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Provider Name | LAUREN STERN WYNNE PH.D., LPC
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1640 POWERS FERRY RD SE BLDG 9 SUITE 100
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City | MARIETTA
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State | GA
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Zip | 30067-5491
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Country | US
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Telephone | 770-953-0080
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Fax | 770-953-0031
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Provider Business Mailing Address
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Address Line | 2566 OAK AVE
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City | TUCKER
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State | GA
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Zip | 30084-3519
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Country | US
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Telephone | 770-939-8582
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC004108
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License Number State | GA
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