Provider Demographics
NPI:1790893915
Name:PRITCHETT, AMY KENNEDY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KENNEDY
Last Name:PRITCHETT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:PATRICIA
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:840 KENNESAW AVE NW
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7933
Mailing Address - Country:US
Mailing Address - Phone:770-573-1628
Mailing Address - Fax:678-354-6227
Practice Address - Street 1:840 KENNESAW AVE NW
Practice Address - Street 2:SUITE 8
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7933
Practice Address - Country:US
Practice Address - Phone:770-573-1628
Practice Address - Fax:678-354-6227
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004652101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA280661333BMedicaid