Provider Demographics
NPI:1538332382
Name:ZIMMERMAN, KATHY (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 HAMMOND DR NE
Mailing Address - Street 2:BLDG. 18, STE. 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5532
Mailing Address - Country:US
Mailing Address - Phone:678-520-4318
Mailing Address - Fax:
Practice Address - Street 1:750 HAMMOND DR NE
Practice Address - Street 2:BLDG. 18, STE. 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5532
Practice Address - Country:US
Practice Address - Phone:678-520-4318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
566139OtherVALUE OPTIONS