Healthcare Provider Details

I. General information

NPI: 1548177348
Provider Name (Legal Business Name): AMELIA KEPHART LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3484 JACKSON DR
DECATUR GA
30032-3036
US

IV. Provider business mailing address

3484 JACKSON DR
DECATUR GA
30032-3036
US

V. Phone/Fax

Practice location:
  • Phone: 770-851-0947
  • Fax:
Mailing address:
  • Phone: 770-851-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC07133
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: