Provider Demographics
NPI:1164666525
Name:MORTENSEN, LYNET SABRINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LYNET
Middle Name:SABRINE
Last Name:MORTENSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3188 ATLANTA RD SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8256
Mailing Address - Country:US
Mailing Address - Phone:770-319-6000
Mailing Address - Fax:770-219-6330
Practice Address - Street 1:3188 ATLANTA RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-8256
Practice Address - Country:US
Practice Address - Phone:770-319-6000
Practice Address - Fax:770-219-6330
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0038141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical