Provider Demographics
NPI:1528303716
Name:KEMP, LAURA R (LCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:R
Last Name:KEMP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4157 BROOKHAVEN DR SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-3195
Mailing Address - Country:US
Mailing Address - Phone:770-788-8607
Mailing Address - Fax:770-229-3223
Practice Address - Street 1:139 HENRY PKWY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6636
Practice Address - Country:US
Practice Address - Phone:770-358-5252
Practice Address - Fax:770-229-3223
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2054OtherMEDICARE
GA000601609GMedicaid