Provider Demographics
NPI:1285762740
Name:OVERTON, LYNN
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:OVERTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 TENCH RD
Mailing Address - Street 2:SUITE 730
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6739
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4485 TENCH RD
Practice Address - Street 2:SUITE 730
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6739
Practice Address - Country:US
Practice Address - Phone:678-714-3924
Practice Address - Fax:678-714-3929
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001610101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional