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Individual

IVIE PAGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1518 AIRPORT RD, HINESVILLE, GA 31313-9439
(912) 559-5536
(614) 388-3712
Mailing address
1518 AIRPORT RD, HINESVILLE, GA 31313-9439
(912) 559-5536
(614) 388-3712

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary

Other

Enumeration date
07/08/2016
Last updated
05/20/2021
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