Individual
ALIESHA MUMFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
116 PIERCE AVE, MACON, GA 31204-2891
(478) 464-3004
Mailing address
104 WILLIAM JOHN LN, BONAIRE, GA 31005-4314
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MSW008638
GA
Other
Enumeration date
04/11/2022
Last updated
04/11/2022
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