Healthcare Provider Details

I. General information

NPI: 1548252323
Provider Name (Legal Business Name): KRISTI L MAXWELL MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 GOVERNORS SQ STE A
PEACHTREE CITY GA
30269-4861
US

IV. Provider business mailing address

130 SEDGEWICKE DR
PEACHTREE CITY GA
30269-4055
US

V. Phone/Fax

Practice location:
  • Phone: 404-444-0005
  • Fax: 770-515-8819
Mailing address:
  • Phone: 404-444-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3177
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: