Provider Demographics
NPI:1225135874
Name:KELAVA, KATE (MS, EDS, LPC)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:KELAVA
Suffix:
Gender:F
Credentials:MS, EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 CHANSON WAY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2168
Mailing Address - Country:US
Mailing Address - Phone:770-597-3720
Mailing Address - Fax:206-666-5279
Practice Address - Street 1:1640 POWERS FERRY RD SE
Practice Address - Street 2:BUILDING 9, SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:770-953-0080
Practice Address - Fax:770-953-0031
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004694101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional