Provider Demographics
NPI:1699038307
Name:INCIA, LLC
Entity Type:Organization
Organization Name:INCIA, LLC
Other - Org Name:LYNDA O. HAMMOND, LPC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:O
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:229-483-5050
Mailing Address - Street 1:1511 W 3RD AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3658
Mailing Address - Country:US
Mailing Address - Phone:229-483-5050
Mailing Address - Fax:
Practice Address - Street 1:1511 W 3RD AVE STE 104
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3658
Practice Address - Country:US
Practice Address - Phone:229-483-5050
Practice Address - Fax:229-485-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002586101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA453120516BMedicaid