Healthcare Provider Details

I. General information

NPI: 1083261358
Provider Name (Legal Business Name): KRISTOLE NICHOLE PIERCE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 FORSYTH ST SW STE 300
ATLANTA GA
30303-3700
US

IV. Provider business mailing address

PO BOX 373303
DECATUR GA
30037-3303
US

V. Phone/Fax

Practice location:
  • Phone: 404-521-2410
  • Fax:
Mailing address:
  • Phone: 678-953-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC010711
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: