Provider Demographics
NPI:1578900122
Name:CAMARATA, KELLY (MED, LPC,CAADC, SA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CAMARATA
Suffix:
Gender:F
Credentials:MED, LPC,CAADC, SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MARGIE CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-3105
Mailing Address - Country:US
Mailing Address - Phone:404-277-3747
Mailing Address - Fax:
Practice Address - Street 1:35 ATLANTA ST
Practice Address - Street 2:SUITE #5-B
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-2162
Practice Address - Country:US
Practice Address - Phone:678-758-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008262101YP2500X
GAC0168101YA0400X
GAAPC003811101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional