Provider Demographics
NPI:1134460967
Name:KENNESAW STATE UNIVERSITY
Entity Type:Organization
Organization Name:KENNESAW STATE UNIVERSITY
Other - Org Name:KENNESAW STATE UNIVERSITY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROCUREMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-420-4355
Mailing Address - Street 1:1000 CHASTAIN RD NW
Mailing Address - Street 2:MD5300 HOUSE 53
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5588
Mailing Address - Country:US
Mailing Address - Phone:678-797-2018
Mailing Address - Fax:678-797-2407
Practice Address - Street 1:5050 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3995
Practice Address - Country:US
Practice Address - Phone:972-367-4845
Practice Address - Fax:972-367-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty