Basic Information
| Provider Information | |||||||||
| NPI: | 1811436496 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPARLING | ||||||||
| FirstName: | LYNN | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1502 BENTON BLVD APT 4101 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314075146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159837149 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4000 SMITHTOWN RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | SUWANEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300246560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4706324990 | ||||||||
| FaxNumber: | 3175208200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2017 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-16-24018 | GA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.