Healthcare Provider Details

I. General information

NPI: 1922932284
Provider Name (Legal Business Name): KOTIA OWENS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 BRECKINRIDGE BLVD STE 200
DULUTH GA
30096-4959
US

IV. Provider business mailing address

3350 BRECKINRIDGE BLVD STE 200
DULUTH GA
30096-4959
US

V. Phone/Fax

Practice location:
  • Phone: 770-962-8396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC015867
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: