Healthcare Provider Details

I. General information

NPI: 1700635778
Provider Name (Legal Business Name): KARLIE CLIFTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 STONE VILLAGE LN NW STE 101
KENNESAW GA
30152-7778
US

IV. Provider business mailing address

1690 STONE VILLAGE LN NW STE 101
KENNESAW GA
30152-7778
US

V. Phone/Fax

Practice location:
  • Phone: 470-344-8902
  • Fax:
Mailing address:
  • Phone: 470-344-8902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: