Provider Demographics
NPI:1366970543
Name:KIM HIOTT, LLC
Entity type:Organization
Organization Name:KIM HIOTT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-549-2255
Mailing Address - Street 1:260 GRAYSON MANOR DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-7824
Mailing Address - Country:US
Mailing Address - Phone:678-549-2255
Mailing Address - Fax:
Practice Address - Street 1:3617 BRASELTON HWY STE 104
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4667
Practice Address - Country:US
Practice Address - Phone:678-549-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003191800AMedicaid
GA003134243AMedicaid