Healthcare Provider Details

I. General information

NPI: 1972971521
Provider Name (Legal Business Name): ALEXANDER KOHL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KENNESAW AVE NW STE 250
MARIETTA GA
30060-7944
US

IV. Provider business mailing address

800 KENNESAW AVE NW STE 250
MARIETTA GA
30060-7944
US

V. Phone/Fax

Practice location:
  • Phone: 470-217-7347
  • Fax:
Mailing address:
  • Phone: 470-217-7347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC009495
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: