Provider Demographics
NPI:1174530703
Name:KALLISH, ROCHELLE (EDS, LPC)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:KALLISH
Suffix:
Gender:F
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 SUGARLOAF PKWY
Mailing Address - Street 2:SUITE 1103
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7831
Mailing Address - Country:US
Mailing Address - Phone:770-665-2641
Mailing Address - Fax:
Practice Address - Street 1:5435 SUGARLOAF PKWY
Practice Address - Street 2:SUITE 1103
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7831
Practice Address - Country:US
Practice Address - Phone:770-665-2641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1594101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional