Individual
KEVIN SCOTT FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
186 TESNATEE LANDING DR, CLEVELAND, GA 30528-3874
(912) 278-2729
Mailing address
186 TESNATEE LANDING DR, CLEVELAND, GA 30528-3874
(912) 278-2729
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC012657
GA
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
02/26/2018
Last updated
01/24/2022
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