Individual
IRISS MICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
455 WINN WAY, DECATUR, GA 30030-1707
(404) 508-6430
Mailing address
445 WINN WAY, DECATUR, GA 30030-1707
(404) 294-3835
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
MSW009542
GA
Other
Enumeration date
06/13/2024
Last updated
06/13/2024
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