Provider Demographics
NPI:1770345480
Name:SANDIFER, KATHRYN HUNTER (LPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:HUNTER
Last Name:SANDIFER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2962 MAJESTIC CIR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE ESTATES
Mailing Address - State:GA
Mailing Address - Zip Code:30002-1610
Mailing Address - Country:US
Mailing Address - Phone:404-386-4150
Mailing Address - Fax:
Practice Address - Street 1:1945 MASON MILL RD STE 100
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4075
Practice Address - Country:US
Practice Address - Phone:404-386-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional