Provider Demographics
NPI:1407300155
Name:HORNSBY, KRISTIN (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:HORNSBY
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6912 FLAGSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-5232
Mailing Address - Country:US
Mailing Address - Phone:404-431-8986
Mailing Address - Fax:
Practice Address - Street 1:2070 BUFORD HWY STE 1B
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-6097
Practice Address - Country:US
Practice Address - Phone:404-431-8986
Practice Address - Fax:678-280-1376
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001396106H00000X
GA008183101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA008183OtherLICENSE NUMBER
GA001396OtherLICENSE NUMBER
GA003187506AMedicaid