Provider Demographics
NPI:1770912420
Name:LK PSYCH HEALTH
Entity type:Organization
Organization Name:LK PSYCH HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KONDILIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:678-701-9559
Mailing Address - Street 1:675 SEMINOLE AVE NE STE 307
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-3416
Mailing Address - Country:US
Mailing Address - Phone:678-701-9559
Mailing Address - Fax:855-611-1918
Practice Address - Street 1:675 SEMINOLE AVE NE STE 307
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-3416
Practice Address - Country:US
Practice Address - Phone:678-701-9559
Practice Address - Fax:855-611-1918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty