Provider Demographics
NPI:1023555315
Name:GOODWIN, LYNN (MA, LAPC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MA, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 EVANS MILL RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3404
Mailing Address - Country:US
Mailing Address - Phone:404-398-7188
Mailing Address - Fax:
Practice Address - Street 1:3651 EVANS MILL RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-3404
Practice Address - Country:US
Practice Address - Phone:404-398-7188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005524101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional