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General NPI Number Information
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NPI Number | 1023826385
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Entity Type | Individual
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Provider Name | KIANNA PORTER-SIMONS
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Gender |
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 235 E PONCE DE LEON AVE STE 320
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City | DECATUR
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State | GA
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Zip | 30030-5800
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Country | US
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Telephone | 404-236-9356
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 HAMILTON DR
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City | LOCUST GROVE
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State | GA
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Zip | 30248-2822
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Country | US
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Telephone | 770-558-0622
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | GA
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