Provider Demographics
NPI:1346880408
Name:CARPENTER, LYNDA M (LPC)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:M
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:M
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2498 JETT FERRY RD STE 205
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-3062
Mailing Address - Country:US
Mailing Address - Phone:470-344-4969
Mailing Address - Fax:
Practice Address - Street 1:2498 JETT FERRY RD STE 205
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-3062
Practice Address - Country:US
Practice Address - Phone:470-344-4969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011297101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional