Provider Demographics
NPI:1285887398
Name:WAGNER, LYNN (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:
Last Name:WAGNER
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 1:28001 BUFORD HIGHWAY
Mailing Address - Street 2:SUITE T-60
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-0000
Mailing Address - Country:US
Mailing Address - Phone:770-715-5725
Mailing Address - Fax:
Practice Address - Street 1:2801 BUFORD HWY NE
Practice Address - Street 2:SUITE T-60
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2149
Practice Address - Country:US
Practice Address - Phone:770-715-5725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005429101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional