Provider Demographics
NPI:1700324118
Name:COOK, LYNN H
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:H
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1212 MELROSE WOODS LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-2363
Mailing Address - Country:US
Mailing Address - Phone:678-910-3779
Mailing Address - Fax:
Practice Address - Street 1:700 OLD ROSWELL LAKES PKWY
Practice Address - Street 2:SUITE 700
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1693
Practice Address - Country:US
Practice Address - Phone:678-910-3779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006414101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor