Provider Demographics
NPI:1831894757
Name:POLLARD, KELLEY NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:NICOLE
Last Name:POLLARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:KELLEY
Other - Middle Name:NICOLE
Other - Last Name:POLLARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:4751 HABERSHAM WAY SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-4407
Mailing Address - Country:US
Mailing Address - Phone:404-643-7452
Mailing Address - Fax:
Practice Address - Street 1:4751 HABERSHAM WAY SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-4407
Practice Address - Country:US
Practice Address - Phone:140-464-3745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012781101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health