Provider Demographics
NPI:1811328644
Name:CALLAHAN, KATHY (LAPC)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 DAHLONEGA ST STE B1902
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8216
Mailing Address - Country:US
Mailing Address - Phone:678-371-7357
Mailing Address - Fax:770-888-1800
Practice Address - Street 1:327 DAHLONEGA ST STE B1902
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8216
Practice Address - Country:US
Practice Address - Phone:678-371-7357
Practice Address - Fax:770-888-1800
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALAPC 004053101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAPC004053OtherLAPC