MEDICARE: TREVOR T KNIGHT 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	LPC008502	GA

General Provider Information

NPI Number	:	1952800864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR T KNIGHT LPC

Provider Business Mailing Address
First Line	:	656 SIMON IVE DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30045-8564
Country	:	US
Telephone Number	:	404-556-9544
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 LONGLEAF BLVD
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-8459
Country	:	US
Telephone Number	:	404-556-9544
Fax Number	:

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

Provider Enumeration Date	:	02/06/2018
Last Update Date	:	02/06/2018

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