Healthcare Provider Details

I. General information

NPI: 1154338903
Provider Name (Legal Business Name): KRISTYN STREEVER SNEDDEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 COMMERCE PKWY UNIT C
CORNELIA GA
30531-5473
US

IV. Provider business mailing address

166 COMMERCE PKWY UNIT C
CORNELIA GA
30531-5473
US

V. Phone/Fax

Practice location:
  • Phone: 706-778-0954
  • Fax: 833-226-0131
Mailing address:
  • Phone: 706-778-0954
  • Fax: 833-226-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW001239
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: