Healthcare Provider Details

I. General information

NPI: 1104952126
Provider Name (Legal Business Name): JONATHAN CHARLES KERR LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CHAPEL DR
TOCCOA FALLS GA
30598-9600
US

IV. Provider business mailing address

644 ACRE EST
TOCCOA GA
30577-8137
US

V. Phone/Fax

Practice location:
  • Phone: 706-282-0824
  • Fax:
Mailing address:
  • Phone: 706-244-0245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC0003513
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: