Individual
LYNETTE SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1816 WALKER ST, AUGUSTA, GA 30904-3659
(706) 863-9971
Mailing address
PO BOX 204048, AUGUSTA, GA 30917-4048
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
G0140004
GA
101YP2500X
Professional Counselor
Primary
LPC006226
GA
163WC0400X
Case Management Registered Nurse
RN219659
GA
Other
Enumeration date
05/23/2013
Last updated
05/23/2013
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