Provider Demographics
NPI:1912447020
Name:LIN, KAYLA
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 JOHNS CREEK CT
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1224
Mailing Address - Country:US
Mailing Address - Phone:770-753-0350
Mailing Address - Fax:770-497-9536
Practice Address - Street 1:3905 JOHNS CREEK CT
Practice Address - Street 2:SUITE 260
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1224
Practice Address - Country:US
Practice Address - Phone:770-753-0350
Practice Address - Fax:770-497-9536
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005632101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor