Provider Demographics
NPI:1568121861
Name:DAVIS, KHRYSTAL R (LPC, CPCS)
Entity Type:Individual
Prefix:MRS
First Name:KHRYSTAL
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC, CPCS
Other - Prefix:MISS
Other - First Name:KHRYSTAL
Other - Middle Name:R
Other - Last Name:CAUPAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1445 WOODMONT LN NW # 2738
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2866
Mailing Address - Country:US
Mailing Address - Phone:678-383-0382
Mailing Address - Fax:
Practice Address - Street 1:7317 CARDIGAN CIR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1951
Practice Address - Country:US
Practice Address - Phone:140-451-0576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health