Provider Demographics
NPI:1578200069
Name:BAMMES, KIA MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KIA
Middle Name:MARIE
Last Name:BAMMES
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 1:2776 COVE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4714
Mailing Address - Country:US
Mailing Address - Phone:470-677-4147
Mailing Address - Fax:
Practice Address - Street 1:2776 COVE VIEW CT
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4714
Practice Address - Country:US
Practice Address - Phone:470-677-4147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012905101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty