Provider Demographics
NPI:1396979704
Name:VANN, KIAHNI ALEXIS (LAPC)
Entity type:Individual
Prefix:MS
First Name:KIAHNI
Middle Name:ALEXIS
Last Name:VANN
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4319 COVINGTON HWY
Mailing Address - Street 2:SUITE #214
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-1210
Mailing Address - Country:US
Mailing Address - Phone:404-200-0334
Mailing Address - Fax:404-287-1807
Practice Address - Street 1:4319 COVINGTON HWY
Practice Address - Street 2:SUITE #214
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-1210
Practice Address - Country:US
Practice Address - Phone:404-200-0334
Practice Address - Fax:404-287-1807
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002129101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional