Provider Demographics
NPI:1871890269
Name:DALY, KEVIN F (MA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:F
Last Name:DALY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 801096
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-1096
Mailing Address - Country:US
Mailing Address - Phone:770-314-0293
Mailing Address - Fax:
Practice Address - Street 1:5205 STILESBORO RD NW STE 225
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7748
Practice Address - Country:US
Practice Address - Phone:678-278-8345
Practice Address - Fax:800-634-6360
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA575101YP1600X
GA09103511101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral