Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LPC006381 | GA |
N | 101YP1600X | Pastoral Counselor | LPC006381 | GA |
Y | 101YP2500X | Professional Counselor | LPC006381 | GA |
NPI | 1134460884 |
---|---|
Provider Name | Lynn Louise Burke Reyes |
First Address | Augusta, GA 30909-9641 |
Second Address | Augusta, GA 30909-9641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2013 |
Last Update Date | 05/03/2013 |