Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | APC002550 | GA |
Y | 103K00000X | Behavior Analyst | APC002550 | GA |
N | 103TC1900X | Counseling Psychologist | APC002550 | GA |
NPI | 1053636860 |
---|---|
Provider Name | Kimberly Marie Seheult |
First Address | Kennesaw, GA 30144 |
Second Address | Kennesaw, GA 30144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2010 |
Last Update Date | 05/04/2010 |