Provider Demographics
NPI:1184911190
Name:KISH, VIVIAN (LPC)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:KISH
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 1:1458 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-9401
Mailing Address - Country:US
Mailing Address - Phone:912-877-7928
Mailing Address - Fax:614-388-3712
Practice Address - Street 1:1458 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-9401
Practice Address - Country:US
Practice Address - Phone:912-877-7928
Practice Address - Fax:614-388-3712
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004363101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional