Provider Demographics
NPI:1558727214
Name:GREEN, LYNDA R (MS, LPC, NCC, BC-TMH)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:R
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS, LPC, NCC, BC-TMH
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:RUTH
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:426 NORTHROP PLACE
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813
Mailing Address - Country:US
Mailing Address - Phone:706-910-4970
Mailing Address - Fax:
Practice Address - Street 1:426 NORTHROP PLACE
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813
Practice Address - Country:US
Practice Address - Phone:706-910-4970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011419101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health