Provider Demographics
NPI:1376025643
Name:KIMSEY, FAITHE BEANNE (MS, LPC, NCC)
Entity Type:Individual
Prefix:MISS
First Name:FAITHE
Middle Name:BEANNE
Last Name:KIMSEY
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3883 ROGERS BRIDGE ROAD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:770-329-5405
Mailing Address - Fax:
Practice Address - Street 1:3883 ROGERS BRIDGE ROAD NW
Practice Address - Street 2:SUITE 601
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097
Practice Address - Country:US
Practice Address - Phone:770-329-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional