Provider Demographics
NPI:1093812992
Name:SMITH, LYNDA RENEE (PHD)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 GODBY ROAD
Mailing Address - Street 2:SUITE #207
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5019
Mailing Address - Country:US
Mailing Address - Phone:404-669-8557
Mailing Address - Fax:404-669-0497
Practice Address - Street 1:2227 GODBY ROAD
Practice Address - Street 2:SUITE #207
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5019
Practice Address - Country:US
Practice Address - Phone:404-669-8557
Practice Address - Fax:404-669-0497
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001924LPC103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist