Provider Demographics
NPI:1235672098
Name:KOK, AMOR (LPC)
Entity type:Individual
Prefix:MRS
First Name:AMOR
Middle Name:
Last Name:KOK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:AMORENTIA
Other - Middle Name:
Other - Last Name:KOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:102 COUNTRY CLUB CT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1311
Mailing Address - Country:US
Mailing Address - Phone:770-631-3522
Mailing Address - Fax:
Practice Address - Street 1:102 COUNTRY CLUB CT
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1311
Practice Address - Country:US
Practice Address - Phone:770-631-3522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003772101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional