Provider Demographics
NPI:1083261358
Name:PIERCE, KRISTOLE NICHOLE (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTOLE
Middle Name:NICHOLE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 373303
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30037-3303
Mailing Address - Country:US
Mailing Address - Phone:678-953-4480
Mailing Address - Fax:
Practice Address - Street 1:236 FORSYTH ST SW STE 300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3700
Practice Address - Country:US
Practice Address - Phone:404-521-2410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010711101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional