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General NPI Number Information
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NPI Number | 1871244921
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Entity Type | Individual
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Provider Name | KANISHKA PRATISH PATEL MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 01/11/2022
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 5901 PEACHTREE DUNWOODY RD STE A-225
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City | ATLANTA
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State | GA
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Zip | 30328-5382
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Country | US
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Telephone | 404-941-2183
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Fax |
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Provider Business Mailing Address
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Address Line | 1108 WOODTRACE LN
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City | AUBURN
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State | GA
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Zip | 30011-4721
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Country | US
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Telephone | 678-308-0214
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | APC008315
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License Number State | GA
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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 | LPC014489
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License Number State | GA
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