Provider Demographics
NPI:1992868608
Name:SHIRLEY, LYNN KING (LPC)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:KING
Last Name:SHIRLEY
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:PO BOX 1013
Mailing Address - Street 2:
Mailing Address - City:SILVER CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30173-1013
Mailing Address - Country:US
Mailing Address - Phone:770-378-9024
Mailing Address - Fax:770-783-8003
Practice Address - Street 1:120 RELAY RD
Practice Address - Street 2:
Practice Address - City:SILVER CREEK
Practice Address - State:GA
Practice Address - Zip Code:30173
Practice Address - Country:US
Practice Address - Phone:770-378-9024
Practice Address - Fax:770-783-8003
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional