Provider Demographics
NPI:1215085733
Name:DAYTON, KELLY MICHELLE (LPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MICHELLE
Last Name:DAYTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MICHELLE
Other - Last Name:PRICHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7328 LITANY COURT
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542
Mailing Address - Country:US
Mailing Address - Phone:404-697-9070
Mailing Address - Fax:404-378-2394
Practice Address - Street 1:5203 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-3334
Practice Address - Country:US
Practice Address - Phone:404-069-7907
Practice Address - Fax:678-828-9944
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4335101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA764330209AMedicaid