MEDICARE: KDC CONSULTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LICENSE	OTHER	GA	LCSW5562

General Provider Information

NPI Number	:	1366033730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KDC CONSULTING LLC

Provider Business Mailing Address
First Line	:	2598 JACANAR LN SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8017
Country	:	US
Telephone Number	:	404-769-8016
Fax Number	:

Provider Business Practice Location Address
First Line	:	2598 JACANAR LN SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8017
Country	:	US
Telephone Number	:	404-769-8016
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KOURTNEY DENISE CARTER
Credential	:	LCSW
Telephone Number	:	404-769-8016

Provider Enumeration Date	:	01/28/2021
Last Update Date	:	01/28/2021

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