Provider Demographics
NPI:1902012925
Name:BOYLES, LYNN A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:A
Last Name:BOYLES
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 1:463 ERNEST BILES DR STE B
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-2229
Mailing Address - Country:US
Mailing Address - Phone:770-775-6645
Mailing Address - Fax:770-775-1154
Practice Address - Street 1:463 ERNEST BILES DR STE B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-2229
Practice Address - Country:US
Practice Address - Phone:770-775-6645
Practice Address - Fax:770-775-1154
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0027621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical