Healthcare Provider Details

I. General information

NPI: 1659064558
Provider Name (Legal Business Name): SAMMY KANSO MS, LAPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4290 BELLS FERRY RD NW STE 134-2134
KENNESAW GA
30144-7140
US

IV. Provider business mailing address

4290 BELLS FERRY RD NW STE 134-2134
KENNESAW GA
30144-7140
US

V. Phone/Fax

Practice location:
  • Phone: 404-913-1615
  • Fax:
Mailing address:
  • Phone: 404-913-1615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC016292
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: