Active NPI
Kindrica Fannin
- Mental Health Counselor
- Atlanta, GA
National Provider Identifier
1629652847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC008070
- Practice address
- 4488 Bellwood Cir
Atlanta, GA 30349-7005 - Phone
- (404) 402-2821
- NPI assigned
- May 12, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LPC008070 | GA | Primary |
Addresses
Primary practice location
4488 Bellwood Cir
Atlanta, GA 30349-7005
Mailing address
4488 Bellwood Cir
Atlanta, GA 30349-7005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC008070 | GA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722902400000",
"number": "1629652847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4488 BELLWOOD CIR",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303497005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4488 BELLWOOD CIR",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303497005",
"telephone_number": "404-402-2821"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANNIN",
"first_name": "KINDRICA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-12",
"last_updated": "2024-08-06",
"certification_date": "2024-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "GA",
"license": "LPC008070",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.