Provider Demographics
NPI:1902163454
Name:KODA, LINSEY DIXON (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:LINSEY
Middle Name:DIXON
Last Name:KODA
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:LINSEY
Other - Middle Name:JUNE
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, NCC, S/T
Mailing Address - Street 1:319 WELTON WAY
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-2842
Mailing Address - Country:US
Mailing Address - Phone:470-764-1330
Mailing Address - Fax:470-554-7044
Practice Address - Street 1:21 EASTBROOK BND
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1546
Practice Address - Country:US
Practice Address - Phone:470-764-1330
Practice Address - Fax:470-554-7044
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional