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General NPI Number Information
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NPI Number | 1992923395
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Entity Type | Individual
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Provider Name | DR. YVONNE VICKERY PENNINGTON
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Gender | Female
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 300 WEST WIEUCA RD BLG 2 STE 314
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City | ATLANTA
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State | GA
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Zip | 30312
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Country | US
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Telephone | 404-255-6967
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Fax |
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Provider Business Mailing Address
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Address Line | 2760 TIMBERLINE RD NE
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City | MARIETTA
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State | GA
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Zip | 30062-1572
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Country | US
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Telephone | 404-255-6967
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Fax | 404-843-8301
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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 | LPC875
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2248
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT502
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License Number State | GA
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