Provider Demographics
NPI:1962892414
Name:VICKERS, LYNZE D (LMFT)
Entity type:Individual
Prefix:MRS
First Name:LYNZE
Middle Name:D
Last Name:VICKERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LYNZE
Other - Middle Name:
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:3415 DEERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31606-0646
Mailing Address - Country:US
Mailing Address - Phone:334-401-0595
Mailing Address - Fax:
Practice Address - Street 1:3415 DEERFIELD LN
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31606-0646
Practice Address - Country:US
Practice Address - Phone:334-401-0595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001430106H00000X
FLMT3560106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty