Provider Demographics
NPI:1215301767
Name:KERLIN, ANN MARIE (PHD, LPC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:KERLIN
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 TANGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-4110
Mailing Address - Country:US
Mailing Address - Phone:470-215-6139
Mailing Address - Fax:
Practice Address - Street 1:21 TANGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-4110
Practice Address - Country:US
Practice Address - Phone:470-215-6139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008302101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional