Provider Demographics
NPI:1043450703
Name:PATTERSON, KENYA ADRIAN (LPC)
Entity type:Individual
Prefix:MRS
First Name:KENYA
Middle Name:ADRIAN
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GREENWAY BLVD BOX C
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4358
Mailing Address - Country:US
Mailing Address - Phone:770-812-8710
Mailing Address - Fax:
Practice Address - Street 1:101 QUARTZ DR STE 103A
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-3201
Practice Address - Country:US
Practice Address - Phone:770-812-8863
Practice Address - Fax:770-812-3805
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5005-125101YP2500X
GALPC010446101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100040008Medicaid