Active NPI
Kevin F Daly, M.A.
- Mental Health Counselor
- Kennesaw, GA
National Provider Identifier
1871890269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 09103511
- Practice address
- 5205 Stilesboro Rd NW Ste 225
Kennesaw, GA 30152-7748 - Phone
- (678) 278-8345
- Fax
- (800) 634-6360
- NPI assigned
- Feb 21, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pastoral Counselor | 101YP1600X | 575 | GA | |
| Mental Health Counselor | 101YM0800X | 09103511 | GA | Primary |
Addresses
Primary practice location
5205 Stilesboro Rd NW Ste 225
Kennesaw, GA 30152-7748
Mailing address
PO Box 801096
Acworth, GA 30101-1096
Phone (770) 314-0293
Other practice location 1
3950 Cobb Parkway
Suite 902
Acworth, GA 30101
Phone (800) 910-5060 ext. 2
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09103511 | GA | MD | Mental Health Counselor |
| 575 | GA | MD | Pastoral Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Broken Chains International | Mental Health | Past | Accepting new patients |
| Broken Chains International, Inc | Pastoral | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Counselor
- Acworth, GA
- NPI 1053727248
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1871890269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 801096",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301011096",
"telephone_number": "770-314-0293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5205 STILESBORO RD NW STE 225",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301527748",
"telephone_number": "678-278-8345",
"fax_number": "800-634-6360"
}
],
"practiceLocations": [
{
"address_1": "3950 Cobb Parkway",
"address_2": "Suite 902",
"address_purpose": "LOCATION",
"city": "Acworth",
"state": "GA",
"postal_code": "30101",
"country_code": "US",
"telephone_number": "800-910-5060 x2",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DALY",
"first_name": "KEVIN",
"middle_name": "F",
"credential": "M.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-02-21",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP1600X",
"taxonomy_group": "",
"desc": "Counselor, Pastoral",
"state": "GA",
"license": "575",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "GA",
"license": "09103511",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.