Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0700X | Adult Development & Aging Psychologist | MFT000296 | GA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | MFT000296 | GA |
N | 103TC1900X | Counseling Psychologist | MFT000296 | GA |
NPI | 1023158466 |
---|---|
Provider Name | Lynette Virginia Farr |
First Address | Stockbridge, GA 30281-7214 |
Second Address | Stockbridge, GA 30281-7214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 12/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43-2052027 | (02) | GA |