MEDICARE: DR. KIMBERLY VAY EDD, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	APC004161	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000	OTHER		NONE

General Provider Information

NPI Number	:	1164870028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY VAY EDD, LPC

Provider Business Mailing Address
First Line	:	3284 NORTHSIDE PKWY NW
Second Line	:	SUITE 570
City	:	ATLANTA
State	:	GA
Zip	:	30327-2280
Country	:	US
Telephone Number	:	404-875-4551
Fax Number	:

Provider Business Practice Location Address
First Line	:	3284 NORTHSIDE PKWY NW
Second Line	:	SUITE 570
City	:	ATLANTA
State	:	GA
Zip	:	30327-2280
Country	:	US
Telephone Number	:	404-875-4551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	06/23/2016

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