Provider Demographics
NPI:1801541057
Name:EASTIN, KAYTIE DORENE (LCSW)
Entity type:Individual
Prefix:
First Name:KAYTIE
Middle Name:DORENE
Last Name:EASTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 PACES FERRY RD SE STE 357
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5729
Mailing Address - Country:US
Mailing Address - Phone:770-726-9589
Mailing Address - Fax:
Practice Address - Street 1:4300 PACES FERRY RD SE STE 357
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5729
Practice Address - Country:US
Practice Address - Phone:770-726-9589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW006777101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health