Provider Demographics
NPI:1497014039
Name:LYNN, CHERYL SUZANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:SUZANNE
Last Name:LYNN
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 1:212 W JACKSON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-6100
Mailing Address - Country:US
Mailing Address - Phone:478-290-0560
Mailing Address - Fax:
Practice Address - Street 1:212 W JACKSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-6100
Practice Address - Country:US
Practice Address - Phone:478-290-0560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0046841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical