Provider Demographics
NPI:1457121626
Name:LYON, JOEL DAVID (LPC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:DAVID
Last Name:LYON
Suffix:
Gender:M
Credentials:LPC
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 1662
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-1662
Mailing Address - Country:US
Mailing Address - Phone:706-259-4961
Mailing Address - Fax:706-259-4102
Practice Address - Street 1:2109 CLEVELAND HWY
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-8149
Practice Address - Country:US
Practice Address - Phone:706-259-4961
Practice Address - Fax:706-259-4102
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014406251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health