Provider Demographics
NPI:1023158466
Name:FARR, LYNETTE VIRGINIA (PHD, LMFT)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:VIRGINIA
Last Name:FARR
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7214
Mailing Address - Country:US
Mailing Address - Phone:770-507-4124
Mailing Address - Fax:770-507-4124
Practice Address - Street 1:240 CORPORATE CENTER DR
Practice Address - Street 2:SUITE D
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7214
Practice Address - Country:US
Practice Address - Phone:770-507-4124
Practice Address - Fax:770-507-4124
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000296103TA0700X, 103TB0200X, 103TC1900X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA43-2052027Medicare UPIN