Provider Demographics
NPI:1013657212
Name:SAMPSON, KAITLYN (MS)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 ROSWELL RD APT 513
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-9014
Mailing Address - Country:US
Mailing Address - Phone:404-984-4881
Mailing Address - Fax:
Practice Address - Street 1:3235 S CHEROKEE LN BLDG 1200
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4461
Practice Address - Country:US
Practice Address - Phone:678-740-3757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health