=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356274294
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN SEVCIK LPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2026
-----------------------------------------------------
Last Update Date | 06/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2443 MOUNT VERNON RD
-----------------------------------------------------
City | DUNWOODY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30338-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-977-2204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 447 LANTERN WOOD DR
-----------------------------------------------------
City | SCOTTDALE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30079-6800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-977-2204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LPC016096
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------