Provider Demographics
NPI:1477615383
Name:KLEEMEIER, CAROL P (PHD)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:P
Last Name:KLEEMEIER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 HABERSHAM AT NORTHLAKE
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084
Mailing Address - Country:US
Mailing Address - Phone:770-939-3073
Mailing Address - Fax:770-939-3275
Practice Address - Street 1:3580 HABERSHAM AT NORTHLAKE
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084
Practice Address - Country:US
Practice Address - Phone:770-939-3073
Practice Address - Fax:770-939-3275
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA506103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000612917AMedicaid