Individual
NEA KRPO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1640 POWERS FERRY RD SE STE 301, MARIETTA, GA 30067-5491
(949) 609-9437
Mailing address
1640 POWERS FERRY RD SE STE 301, MARIETTA, GA 30067-5491
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
AMFT000738
GA
Other
Enumeration date
05/12/2022
Last updated
05/12/2022
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