Healthcare Provider Details

I. General information

NPI: 1861902561
Provider Name (Legal Business Name): KATHERINE KENDALL PERRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2017
Last Update Date: 09/25/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 MAYFIELD RD STE 203
MILTON GA
30009-3012
US

IV. Provider business mailing address

3650 STEVE REYNOLDS BLVD
DULUTH GA
30096-4506
US

V. Phone/Fax

Practice location:
  • Phone: 770-389-8100
  • Fax:
Mailing address:
  • Phone: 706-831-3803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000120576
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005323
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: