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NPI Code Detail

MEDICARE: KIMBERLY LYNN ROTH M.A.

MEDICARE: KIMBERLY LYNN ROTH M.A.
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
1101Y00000XCounselorLPC004836GA
2101YA0400XAddiction (Substance Use Disorder) CounselorLPC004836GA
3101YP2500XProfessional CounselorLPC004836GA

General Provider Information

NPI Number : 1942323100
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY LYNN ROTH M.A.
Provider Business Mailing Address
First Line : 3584 ATLANTA HIGHWAY
Second Line :
City : FLOWERY BRANCH
State : GA
Zip : 30542
Country : US
Telephone Number : 770-535-1050
Fax Number : 678-943-8705
Provider Business Practice Location Address
First Line : 745 S MILLEDGE AVE STE 1A
Second Line :
City : ATHENS
State : GA
Zip : 30605-1292
Country : US
Telephone Number : 706-498-9560
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2007
Last Update Date : 11/19/2024

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