Healthcare Provider Details

I. General information

NPI: 1164870028
Provider Name (Legal Business Name): KIMBERLY VAY EDD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3284 NORTHSIDE PKWY NW SUITE 570
ATLANTA GA
30327-2280
US

IV. Provider business mailing address

3284 NORTHSIDE PKWY NW SUITE 570
ATLANTA GA
30327-2280
US

V. Phone/Fax

Practice location:
  • Phone: 404-875-4551
  • Fax:
Mailing address:
  • Phone: 404-875-4551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC004161
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: