| Mk Psychotherapy, Inc. | |
|
1585 Old Norcross Rd Ste 201d Lawrenceville GA 30046-4043 | |
| (404) 643-2457 | |
| (678) 203-2409 |
| Full Name | Mk Psychotherapy, Inc. |
|---|---|
| Speciality | Social Worker |
| Location | 1585 Old Norcross Rd Ste 201d, Lawrenceville, Georgia |
| Authorized Official Name and Position | Marilyn A Kirkland (PRESIDENT) |
| Authorized Official Contact | 4046432457 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mk Psychotherapy, Inc. 1873 Poplar Rdg Lawrenceville GA 30044-2842 Ph: (404) 643-2457 | Mk Psychotherapy, Inc. 1585 Old Norcross Rd Ste 201d Lawrenceville GA 30046-4043 Ph: (404) 643-2457 |
| NPI Number | 1851513923 |
|---|---|
| Provider Enumeration Date | 05/02/2007 |
| Last Update Date | 09/30/2022 |
| Certification Date | 09/30/2022 |
| Medicare PECOS PAC ID | 7911145198 |
|---|---|
| Medicare Enrollment ID | O20130529000718 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851513923 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CSW001677 (Georgia) | Primary |
| Provider Name | Marilyn A Kirkland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881930071 PECOS PAC ID: 5890779771 Enrollment ID: I20040617000380 |
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