Individual
MICHELLE KN ENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3960 GREENSIDE CT, DACULA, GA 30019-4594
(678) 469-2872
Mailing address
3960 GREENSIDE CT, DACULA, GA 30019-4594
(678) 469-2872
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
11718
GA
Other
Enumeration date
12/08/2025
Last updated
12/08/2025
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