Provider Demographics
NPI:1740365105
Name:TRIMM, KENNETH L
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:L
Last Name:TRIMM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 HIDDEN SPRINGS WALK SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-4254
Mailing Address - Country:US
Mailing Address - Phone:678-444-4505
Mailing Address - Fax:678-606-9316
Practice Address - Street 1:4006 HOLCOMB BRIDGE RD STE 210
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-1814
Practice Address - Country:US
Practice Address - Phone:678-444-4505
Practice Address - Fax:678-606-9316
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor