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General NPI Number Information
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NPI Number | 1851513923
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Entity Type | Organization
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Legal Business Name | MK PSYCHOTHERAPY, INC.
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 1585 OLD NORCROSS RD STE 201D
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4043
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Country | US
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Telephone | 404-643-2457
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Fax | 678-203-2409
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Provider Business Mailing Address
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Address Line | 1873 POPLAR RDG
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2842
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Country | US
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Telephone | 404-643-2457
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Fax | 678-203-2409
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARILYN A KIRKLAND
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Credential | LCSW
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Telephone | 404-643-2457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW001677
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License Number State | GA
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