Individual
MARIE JEAN II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
472 CRESTMONT LN, CANTON, GA 30114-8860
(678) 630-4177
Mailing address
472 CRESTMONT LN, CANTON, GA 30114-8860
(678) 630-4177
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
12/31/2015
Last updated
12/31/2015
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