Provider Demographics
NPI:1992085187
Name:JONES, KIRSTEN PAIGE (LPC)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:PAIGE
Last Name:JONES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:PAIGE
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6247 LITTLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-1632
Mailing Address - Country:US
Mailing Address - Phone:256-239-6659
Mailing Address - Fax:833-759-1551
Practice Address - Street 1:6247 LITTLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-1632
Practice Address - Country:US
Practice Address - Phone:256-239-6659
Practice Address - Fax:833-759-1551
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006674101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003165723AMedicaid