Provider Demographics
NPI:1750013751
Name:WYNN, LASHUNDRA
Entity Type:Individual
Prefix:
First Name:LASHUNDRA
Middle Name:
Last Name:WYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7660
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29861-7660
Mailing Address - Country:US
Mailing Address - Phone:706-843-6241
Mailing Address - Fax:706-843-6242
Practice Address - Street 1:2100 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6717
Practice Address - Country:US
Practice Address - Phone:706-843-6241
Practice Address - Fax:803-843-6242
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional