Individual
KAITLYN IDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2270 CAPE COURAGE WAY, SUWANEE, GA 30024-2762
(470) 201-7804
Mailing address
2133 LAWRENCEVILLE SUWANEE RD STE 12-346, SUWANEE, GA 30024-2648
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC13028
GA
Other
Enumeration date
06/15/2022
Last updated
10/03/2024
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