DWAYNE WAYMAN KILGORE


Address: 1008 N Louise St, Atlanta, TX 75551-1614
Phone: 9037967155

DWAYNE WAYMAN KILGORE (NPI# 1710409230) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1710409230
Entity Type Individual
Full Name DWAYNE WAYMAN KILGORE
Credential LPCC
Practice Address 1008 N Louise St
Atlanta
TX 75551-1614
Mailing Address 5645 Us Highway 59 S
Jefferson
TX 75657-2902
Practice Telephone 9037967155
Mailing Telephone 9036652647
Enumeration Date 2017-07-17
Last Update Date 2018-03-17
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 101YP2500X Counselor
Specialization: Professional
74643 TX Behavioral Health & Social Service Providers

Provider Secondary Practice Location

Address Telephone Number Fax Number
1008 N Louise St, Atlanta, TX 755511614 9037967155 9037967447

Office Location

Street Address 1008 N LOUISE ST
City ATLANTA
State TX
Zip Code 75551-1614

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Taxonomy Information

Taxonomy Code 101YP2500X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Professional

Taxonomy Definition

Definition to come...

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Competitor

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City ATLANTA
Zip Code 75551

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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