Provider Demographics
NPI:1871859967
Name:HAIDER-BARDILL, KENNETH CHRISTOPHER (LPC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:CHRISTOPHER
Last Name:HAIDER-BARDILL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 LENA ST NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-2953
Mailing Address - Country:US
Mailing Address - Phone:678-488-0766
Mailing Address - Fax:
Practice Address - Street 1:1060 LENA ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-2953
Practice Address - Country:US
Practice Address - Phone:678-488-0766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC003325101YP2500X
GALPC008084101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional