Provider Demographics
NPI:1255764825
Name:MCKNIGHT, MONTIA J (MS, LPC)
Entity type:Individual
Prefix:
First Name:MONTIA
Middle Name:J
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:J
Other - Last Name:MCKNIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:3346 MUSCADINE TRL NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3346 MUSCADINE TRL NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5020
Practice Address - Country:US
Practice Address - Phone:770-362-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-18
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003209101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional