Provider Demographics
NPI:1497449128
Name:MOTLEY, KIMBERLY ROLLINS (LPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ROLLINS
Last Name:MOTLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3584 RIDGEWOOD PT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-5545
Mailing Address - Country:US
Mailing Address - Phone:678-697-0953
Mailing Address - Fax:
Practice Address - Street 1:3584 RIDGEWOOD PT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-5545
Practice Address - Country:US
Practice Address - Phone:678-697-0953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional