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General NPI Number Information
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NPI Number | 1043450703
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Entity Type | Individual
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Provider Name | KENYA ADRIAN PATTERSON L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 02/20/2009
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 101 QUARTZ DR STE 103A
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City | VILLA RICA
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State | GA
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Zip | 30180-3201
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Country | US
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Telephone | 770-812-8863
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Fax | 770-812-3805
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Provider Business Mailing Address
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Address Line | 100 GREENWAY BLVD BOX C
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City | CARROLLTON
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State | GA
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Zip | 30117-4358
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Country | US
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Telephone | 770-812-8710
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5005-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC010446
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License Number State | GA
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