Healthcare Provider Details

I. General information

NPI: 1952016297
Provider Name (Legal Business Name): KIARA BALDWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3461 SUMERSBE CT
ATLANTA GA
30349-2976
US

IV. Provider business mailing address

650 PONCE DE LEON AVE NE STE 300
ATLANTA GA
30308-1864
US

V. Phone/Fax

Practice location:
  • Phone: 470-502-5643
  • Fax:
Mailing address:
  • Phone: 470-502-5643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: