Healthcare Provider Details

I. General information

NPI: 1427528181
Provider Name (Legal Business Name): KIRSTIE DIONNE HUDNALL LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2591 CANDLER RD
DECATUR GA
30032-6502
US

IV. Provider business mailing address

2095 SCARBROUGH TRL E
STONE MOUNTAIN GA
30088-4323
US

V. Phone/Fax

Practice location:
  • Phone: 678-209-2710
  • Fax:
Mailing address:
  • Phone: 770-912-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: