Provider Demographics
NPI:1548252323
Name:MAXWELL, KRISTI L (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:L
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SEDGEWICKE DR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4055
Mailing Address - Country:US
Mailing Address - Phone:404-444-0005
Mailing Address - Fax:
Practice Address - Street 1:145 GOVERNORS SQ STE A
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4861
Practice Address - Country:US
Practice Address - Phone:404-444-0005
Practice Address - Fax:770-515-8819
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3177101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3177OtherSTATE LICENSE FOR COUNSEL