| Kaleidosoul Llc | |
|
220 Lanier Ave E Ste 7 Fayetteville GA 30214-1604 | |
| (678) 545-6692 | |
| (678) 519-5673 |
| Full Name | Kaleidosoul Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 220 Lanier Ave E Ste 7, Fayetteville, Georgia |
| Authorized Official Name and Position | Stacey Nicole Paxton (OWNER) |
| Authorized Official Contact | 7854566926 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kaleidosoul Llc 220 Lanier Ave E Ste 7 Fayetteville GA 30214-1604 Ph: (678) 545-6692 | Kaleidosoul Llc 220 Lanier Ave E Ste 7 Fayetteville GA 30214-1604 Ph: (678) 545-6692 |
| NPI Number | 1407594658 |
|---|---|
| Provider Enumeration Date | 05/26/2022 |
| Last Update Date | 09/21/2022 |
| Certification Date | 09/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407594658 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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