Provider Demographics
NPI:1134452485
Name:CONKLIN, JOY LYNN (MS, LPC, NCC, NSCC)
Entity type:Individual
Prefix:MRS
First Name:JOY
Middle Name:LYNN
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:MS, LPC, NCC, NSCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 GOVERNORS SQ STE A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-4862
Mailing Address - Country:US
Mailing Address - Phone:678-364-1300
Mailing Address - Fax:
Practice Address - Street 1:130 GOVERNORS SQ STE A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-4862
Practice Address - Country:US
Practice Address - Phone:678-364-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003064101YP2500X
GA430877101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool