Healthcare Provider Details

I. General information

NPI: 1548210404
Provider Name (Legal Business Name): MS. KIMBERLY L. HIOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. KIMBERLY L. PESCE

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 BRASELTON HWY STE 104
DACULA GA
30019-4667
US

IV. Provider business mailing address

3617 BRASELTON HWY STE 104
DACULA GA
30019-4667
US

V. Phone/Fax

Practice location:
  • Phone: 678-549-2255
  • Fax: 770-783-8927
Mailing address:
  • Phone: 678-549-2255
  • Fax: 770-783-8927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC005898
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4710
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: