Provider Demographics
NPI:1710570593
Name:COCHRAN, KRISTIN LEE (MFT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEE
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:LEE
Other - Last Name:ERWIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:119 DEUN CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-3447
Mailing Address - Country:US
Mailing Address - Phone:770-616-2417
Mailing Address - Fax:
Practice Address - Street 1:02 W MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132
Practice Address - Country:US
Practice Address - Phone:678-332-7955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT002096101YM0800X
GAAPC007170101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMFT002096OtherMARRIAGE AND FAMILY THERAPIST LICENSE