Provider Demographics
NPI:1588006084
Name:BOYER, KEVIN LEE (LPC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:LEE
Last Name:BOYER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 MONTVIEW DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-5138
Mailing Address - Country:US
Mailing Address - Phone:770-315-4898
Mailing Address - Fax:770-457-5867
Practice Address - Street 1:2931 MONTVIEW DR SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-5138
Practice Address - Country:US
Practice Address - Phone:770-315-4898
Practice Address - Fax:770-457-5867
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional