Provider Demographics
NPI:1366006181
Name:AUSTIN, KIM (LPC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:AUSTIN
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 1:70 GRUBER LN STE 170
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-2881
Mailing Address - Country:US
Mailing Address - Phone:770-807-2022
Mailing Address - Fax:
Practice Address - Street 1:3975 ROSWELL RD NE STE 104
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4119
Practice Address - Country:US
Practice Address - Phone:770-807-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010508101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional