Provider Demographics
NPI:1043831688
Name:CONNER, LYNETTE KAY (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:KAY
Last Name:CONNER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BARTLETT CIR
Mailing Address - Street 2:
Mailing Address - City:BOWDON
Mailing Address - State:GA
Mailing Address - Zip Code:30108-1301
Mailing Address - Country:US
Mailing Address - Phone:770-670-8970
Mailing Address - Fax:
Practice Address - Street 1:165 BARTLETT CIR
Practice Address - Street 2:
Practice Address - City:BOWDON
Practice Address - State:GA
Practice Address - Zip Code:30108-1301
Practice Address - Country:US
Practice Address - Phone:770-670-8970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YP2500X
GALPC011415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional