Provider Demographics
NPI:1851906507
Name:WALDREP, KAYE ELIZABETH (LPC)
Entity Type:Individual
Prefix:MS
First Name:KAYE
Middle Name:ELIZABETH
Last Name:WALDREP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KAYE
Other - Middle Name:ELIZABETH
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:330 WINTERBERRY DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3208
Mailing Address - Country:US
Mailing Address - Phone:706-244-1512
Mailing Address - Fax:
Practice Address - Street 1:330 WINTERBERRY DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-3208
Practice Address - Country:US
Practice Address - Phone:706-244-1512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011706101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty