Individual
MIA MOENAE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
137 JOHNSON FERRY RD STE 2170, MARIETTA, GA 30068-4948
(470) 648-0510
Mailing address
137 JOHNSON FERRY RD STE 2170, MARIETTA, GA 30068-4948
(470) 648-0510
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
04/23/2025
Last updated
04/23/2025
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