Organization
ILERA THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY BONVILLAIN (CEO)
(678) 664-8298
Entity
Organization
Contact information
Practice address
300 COLONIAL CENTER PKWY STE 100N, ROSWELL, GA 30076-4892
(678) 664-8298
Mailing address
100 COMMERCE DR UNIT 191, TYRONE, GA 30290-8009
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
03/06/2022
Last updated
03/08/2022
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