Provider Demographics
NPI:1578628988
Name:KYNES, JAMES BERNARD SR (M DIV)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BERNARD
Last Name:KYNES
Suffix:SR
Gender:M
Credentials:M DIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2094
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-2094
Mailing Address - Country:US
Mailing Address - Phone:404-378-2232
Mailing Address - Fax:404-378-2239
Practice Address - Street 1:209 SWANTON WAY
Practice Address - Street 2:# A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3271
Practice Address - Country:US
Practice Address - Phone:404-378-2232
Practice Address - Fax:404-378-2239
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000870106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist