Provider Demographics
NPI:1790141612
Name:KLOTH, MEREDITH (MS, LAPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:
Last Name:KLOTH
Suffix:
Gender:F
Credentials:MS, LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 CHEROKEE AVE SE
Mailing Address - Street 2:STE 202
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3260
Mailing Address - Country:US
Mailing Address - Phone:678-718-7565
Mailing Address - Fax:
Practice Address - Street 1:464 CHEROKEE AVE SE
Practice Address - Street 2:STE 202
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-3260
Practice Address - Country:US
Practice Address - Phone:678-718-7565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC003288101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional