Provider Demographics
NPI:1255130753
Name:HENDRIX, EMMY KATHLEEN
Entity type:Individual
Prefix:
First Name:EMMY
Middle Name:KATHLEEN
Last Name:HENDRIX
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 RALPH MCGILL BLVD NE APT 383H
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1227
Mailing Address - Country:US
Mailing Address - Phone:404-434-2343
Mailing Address - Fax:
Practice Address - Street 1:199 ARMOUR DR NE STE E
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3975
Practice Address - Country:US
Practice Address - Phone:678-883-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008774101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional