Healthcare Provider Details

I. General information

NPI: 1689050676
Provider Name (Legal Business Name): KIMBERLY M LEE-OKONYA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 17TH ST NW SUITE 300
ATLANTA GA
30363
US

IV. Provider business mailing address

PO BOX 722
AUSTELL GA
30168-1051
US

V. Phone/Fax

Practice location:
  • Phone: 678-237-6540
  • Fax:
Mailing address:
  • Phone: 678-237-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005170
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: