Provider Demographics
NPI:1134426570
Name:LIVSEY, KIMBERLY TAYLOR (LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:TAYLOR
Last Name:LIVSEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 HOLLINGSWORTH BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-4036
Mailing Address - Country:US
Mailing Address - Phone:404-295-4224
Mailing Address - Fax:
Practice Address - Street 1:1804 HOLLINGSWORTH BLVD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-4036
Practice Address - Country:US
Practice Address - Phone:404-295-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005863101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003106113AMedicaid