Provider Demographics
NPI:1427338532
Name:FRAZIER LUMPKINS, TAWANNA KAY (PHD LMHC LPC)
Entity type:Individual
Prefix:MRS
First Name:TAWANNA
Middle Name:KAY
Last Name:FRAZIER LUMPKINS
Suffix:
Gender:F
Credentials:PHD LMHC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8158 JENKINS RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30187-1367
Mailing Address - Country:US
Mailing Address - Phone:678-640-0160
Mailing Address - Fax:
Practice Address - Street 1:8158 JENKINS RD
Practice Address - Street 2:
Practice Address - City:WINSTON
Practice Address - State:GA
Practice Address - Zip Code:30187-1367
Practice Address - Country:US
Practice Address - Phone:678-640-0160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FLMH14620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL751351898OtherMEDICAID WAIVER
FL751351896OtherMEDICAID WAIVER