Provider Demographics
NPI:1558409920
Name:KILGORE, STEVEN R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:R
Last Name:KILGORE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1335 CANTON RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6053
Mailing Address - Country:US
Mailing Address - Phone:770-425-1170
Mailing Address - Fax:770-425-1137
Practice Address - Street 1:1335 CANTON RD
Practice Address - Street 2:SUITE C
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-6053
Practice Address - Country:US
Practice Address - Phone:770-425-1170
Practice Address - Fax:770-425-1137
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA10941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical