1902163454 NPI number — MRS. LINSEY DIXON KODA LPC, NCC

Table of content: MRS. LINSEY DIXON KODA LPC, NCC (NPI 1902163454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902163454 NPI number — MRS. LINSEY DIXON KODA LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KODA
Provider First Name:
LINSEY
Provider Middle Name:
DIXON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIXON
Provider Other First Name:
LINSEY
Provider Other Middle Name:
JUNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., NCC, S/T
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902163454
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
319 WELTON WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEACHTREE CITY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30269-2842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-764-1330
Provider Business Mailing Address Fax Number:
470-554-7044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 EASTBROOK BND
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEACHTREE CITY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30269-1546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-764-1330
Provider Business Practice Location Address Fax Number:
470-554-7044
Provider Enumeration Date:
04/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC009571 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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