Provider Demographics
NPI:1487994299
Name:SCHNEIDER, KERRY JOEY (LPC)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:JOEY
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4331 THURMOND TANNER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-2829
Mailing Address - Country:US
Mailing Address - Phone:678-513-5700
Mailing Address - Fax:
Practice Address - Street 1:125 N CORNERS PKWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2078
Practice Address - Country:US
Practice Address - Phone:678-341-3840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006865101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC006865OtherLICENSE