Provider Demographics
NPI:1396034427
Name:LOVE, KISHA (LPC, CPCS)
Entity Type:Individual
Prefix:
First Name:KISHA
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:LPC, CPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1761
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30156-8761
Mailing Address - Country:US
Mailing Address - Phone:404-543-4687
Mailing Address - Fax:
Practice Address - Street 1:1903 PHOENIX BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5700
Practice Address - Country:US
Practice Address - Phone:404-673-9586
Practice Address - Fax:678-229-9906
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007310101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health