Individual
MRS. LYNDA SHANE BLASKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1409 NORTH HIGHLAND AVENUE, SUITE J, ATLANTA, GA 30306
(404) 908-1773
Mailing address
1290 OAKLAWN AVENUE NE, BROOKHAVEN, GA 30319
(404) 908-1773
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
Primary
004067
GA
103TC1900X
Counseling Psychologist
004067
GA
Other
Enumeration date
03/08/2010
Last updated
07/21/2022
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