Provider Demographics
NPI:1285968495
Name:WUNDERLICH, JOY LYNNE (LPC)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:LYNNE
Last Name:WUNDERLICH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 SCARLET OAK DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-8238
Mailing Address - Country:US
Mailing Address - Phone:706-809-0703
Mailing Address - Fax:706-348-6065
Practice Address - Street 1:487 MORRISON MOORE PKWY W
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1422
Practice Address - Country:US
Practice Address - Phone:706-344-8461
Practice Address - Fax:706-348-6065
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004602101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA417124978AMedicaid