Provider Demographics
NPI:1073910121
Name:HOOD, KEISHA NICHOLE (MAMFT, LMFT, LPC)
Entity Type:Individual
Prefix:MS
First Name:KEISHA
Middle Name:NICHOLE
Last Name:HOOD
Suffix:
Gender:F
Credentials:MAMFT, LMFT, LPC
Other - Prefix:
Other - First Name:K
Other - Middle Name:NICHOLE
Other - Last Name:HOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAMFT, LMFT, LPC
Mailing Address - Street 1:167 WORTHINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE SPIVEY
Mailing Address - State:GA
Mailing Address - Zip Code:30236-5588
Mailing Address - Country:US
Mailing Address - Phone:678-671-9908
Mailing Address - Fax:
Practice Address - Street 1:385 COUNTRY CLUB DR
Practice Address - Street 2:SUITE E
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7351
Practice Address - Country:US
Practice Address - Phone:678-671-9908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007995101YP2500X
GAMFT001380106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional