Healthcare Provider Details

I. General information

NPI: 1346811775
Provider Name (Legal Business Name): KRISTEN HERNDON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 WALTON WAY
AUGUSTA GA
30909-3827
US

IV. Provider business mailing address

6325 HARLEM GROVETOWN RD
HARLEM GA
30814-0163
US

V. Phone/Fax

Practice location:
  • Phone: 706-842-3279
  • Fax:
Mailing address:
  • Phone: 706-284-7610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC007472
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: