Healthcare Provider Details

I. General information

NPI: 1114858099
Provider Name (Legal Business Name): KRISTY M. LEDFORD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N BELAIR SQ
EVANS GA
30809-4321
US

IV. Provider business mailing address

1916 PRESERVATION CIR
EVANS GA
30809-0687
US

V. Phone/Fax

Practice location:
  • Phone: 619-762-0167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KRISTY LEDFORD
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LPC
Phone: 619-762-0167