Healthcare Provider Details

I. General information

NPI: 1336737154
Provider Name (Legal Business Name): KRISTIN HORNSBY LPC LMFT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 BUFORD HWY STE 1B
BUFORD GA
30518-6097
US

IV. Provider business mailing address

6912 FLAGSTONE WAY
FLOWERY BRANCH GA
30542-5232
US

V. Phone/Fax

Practice location:
  • Phone: 404-431-8986
  • Fax:
Mailing address:
  • Phone: 404-431-8986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN A HORNSBY
Title or Position: OWNER
Credential: LPC LMFT
Phone: 404-431-8986