MEDICARE: KANISHKA PRATISH PATEL MS, LPC

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	101YP2500X	Professional Counselor	LPC014489	GA
2	101Y00000X	Counselor	APC008315	GA

General Provider Information

NPI Number	:	1871244921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANISHKA PRATISH PATEL MS, LPC

Provider Business Mailing Address
First Line	:	6595 ROSWELL RD STE G2017
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3152
Country	:	US
Telephone Number	:	678-308-0214
Fax Number	:

Provider Business Practice Location Address
First Line	:	6595 ROSWELL RD STE G2017
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3152
Country	:	US
Telephone Number	:	678-308-0214
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2022
Last Update Date	:	05/10/2026

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