Provider Demographics
NPI:1083987481
Name:MONTGOMERY, KRISHAWNA ELAINE (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KRISHAWNA
Middle Name:ELAINE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:51 CROSSCREEK DR NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1202
Mailing Address - Country:US
Mailing Address - Phone:706-331-2235
Mailing Address - Fax:
Practice Address - Street 1:501 MIZE STREET LOOKOUT MOUNTAIN COMMUNITY SERVICES
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728
Practice Address - Country:US
Practice Address - Phone:706-638-5580
Practice Address - Fax:706-638-5445
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008188101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional