Provider Demographics
NPI:1013294966
Name:FARNAM, LYNDI NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNDI
Middle Name:NICOLE
Last Name:FARNAM
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 1:2109 N PATTERSON ST STE B
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2577
Mailing Address - Country:US
Mailing Address - Phone:406-565-0064
Mailing Address - Fax:
Practice Address - Street 1:2109 N PATTERSON ST STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2577
Practice Address - Country:US
Practice Address - Phone:229-232-4833
Practice Address - Fax:877-343-0538
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0052161041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical