Provider Demographics
NPI:1952724460
Name:PAYNE, KRISTINA SARBER (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:SARBER
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 GREATWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WHITE
Mailing Address - State:GA
Mailing Address - Zip Code:30184-2892
Mailing Address - Country:US
Mailing Address - Phone:470-233-4269
Mailing Address - Fax:
Practice Address - Street 1:109 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3905
Practice Address - Country:US
Practice Address - Phone:470-233-4269
Practice Address - Fax:770-383-8930
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007662101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional