Individual
KEJI ITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
2801 BUFORD HWY NE STE 550B, BROOKHAVEN, GA 30329-2124
(770) 912-0234
Mailing address
5564 TRACE VIEWS DR, NORCROSS, GA 30071-1436
(470) 384-3790
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MSW012080
GA
Other
Enumeration date
12/20/2024
Last updated
12/20/2024
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