Provider Demographics
NPI:1518023431
Name:KEMP, TEDDY M (LMFT, LCSW)
Entity type:Individual
Prefix:
First Name:TEDDY
Middle Name:M
Last Name:KEMP
Suffix:
Gender:M
Credentials:LMFT, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 OGLETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2135
Mailing Address - Country:US
Mailing Address - Phone:706-549-7755
Mailing Address - Fax:706-549-0428
Practice Address - Street 1:2201 HOG MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4808
Practice Address - Country:US
Practice Address - Phone:706-549-7755
Practice Address - Fax:706-549-0428
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0018521041C0700X
GA000658106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist