Healthcare Provider Details

I. General information

NPI: 1427416924
Provider Name (Legal Business Name): KIA HANSFORD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 MULKEY RD STE 202
AUSTELL GA
30106-1150
US

IV. Provider business mailing address

PO BOX 813581
SMYRNA GA
30081-8581
US

V. Phone/Fax

Practice location:
  • Phone: 770-694-6349
  • Fax: 770-299-3771
Mailing address:
  • Phone: 770-873-2654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC008358
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: