Individual
AUNTERYO MALCOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1903 PHOENIX BLVD, ATLANTA, GA 30349-5754
(678) 335-9010
Mailing address
1903 PHOENIX BLVD, ATLANTA, GA 30349-5754
(678) 335-9010
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0011786
GA
Other
Enumeration date
12/04/2020
Last updated
12/04/2020
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