Provider Demographics
NPI:1063814713
Name:KITTO, DAWN (MS, LPC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:KITTO
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E PONCE DE LEON AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2512
Mailing Address - Country:US
Mailing Address - Phone:404-618-1101
Mailing Address - Fax:
Practice Address - Street 1:675 SEMINOLE AVE NE STE T03
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-3409
Practice Address - Country:US
Practice Address - Phone:404-249-0520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004560101YM0800X
GALPC009830101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health