Provider Demographics
NPI:1972510030
Name:KELLER, PATRICIA KREIDLER (LPC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:KREIDLER
Last Name:KELLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1344 EAST COBB DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068
Mailing Address - Country:US
Mailing Address - Phone:770-509-0551
Mailing Address - Fax:770-509-0552
Practice Address - Street 1:1344 EAST COBB DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068
Practice Address - Country:US
Practice Address - Phone:770-509-0551
Practice Address - Fax:770-509-0552
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC00158101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional