Provider Demographics
NPI:1689050676
Name:LEE-OKONYA, KIMBERLY M (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:LEE-OKONYA
Suffix:
Gender:F
Credentials:LCSW
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 722
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-1051
Mailing Address - Country:US
Mailing Address - Phone:678-237-6540
Mailing Address - Fax:
Practice Address - Street 1:201 17TH ST NW
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30363
Practice Address - Country:US
Practice Address - Phone:678-237-6540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0051701041C0700X
GA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No374J00000XNursing Service Related ProvidersDoula