Organization
MAGNOLIA INTEGRATED HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIRA IHEME PH.D., LPC (PRESIDENT)
(678) 922-2834
Entity
Organization
Contact information
Practice address
2227 IDLEWOOD RD, SUITE 2, TUCKER, GA 30084-4827
(678) 922-2834
(678) 922-2270
Mailing address
2227 IDLEWOOD RD, SUITE 2, TUCKER, GA 30084-4827
(678) 922-2834
(678) 922-2270
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC002789
GA
101YP2500X
Professional Counselor
LPC003902
GA
101YP2500X
Professional Counselor
LPC005575
GA
101YP2500X
Professional Counselor
LPC006908
GA
1041C0700X
Clinical Social Worker
CSW005116
GA
207Q00000X
Family Medicine Physician
69322
GA
Other
Enumeration date
10/01/2015
Last updated
10/01/2015
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