Provider Demographics
NPI:1447541149
Name:MAYER, KEISHA TENELL (LPC)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:TENELL
Last Name:MAYER
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 1:591 TORONTO CIR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-5336
Mailing Address - Country:US
Mailing Address - Phone:404-453-8255
Mailing Address - Fax:
Practice Address - Street 1:4343 SHALLOWFORD RD
Practice Address - Street 2:SUITE C-1
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5023
Practice Address - Country:US
Practice Address - Phone:404-453-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 007040101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health