Provider Demographics
NPI:1407250335
Name:QUILES, KEVIN (MDIV, MA, LPC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:QUILES
Suffix:
Gender:M
Credentials:MDIV, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11285 ELKINS RD STE D4
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5835
Mailing Address - Country:US
Mailing Address - Phone:770-337-8226
Mailing Address - Fax:770-521-0512
Practice Address - Street 1:11285 ELKINS RD STE D4
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5835
Practice Address - Country:US
Practice Address - Phone:770-337-8226
Practice Address - Fax:770-521-0512
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional