Individual
KELLY MARGARET MACE CIANCIOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
209B SWANTON WAY STE 204, DECATUR, GA 30030-3271
(504) 295-9312
Mailing address
1977 CAMELLIA DR, DECATUR, GA 30032-5205
(504) 295-9312
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
APC006660
GA
Other
Enumeration date
11/13/2018
Last updated
05/31/2022
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