Individual
FARISAI DIX-BROUGHTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
610 KENTUCKY ST, SCOTTDALE, GA 30079-1124
(770) 988-7470
Mailing address
610 KENTUCKY ST, SCOTTDALE, GA 30079-1124
(770) 988-7470
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
APC008628
GA
Other
Enumeration date
10/04/2023
Last updated
10/04/2023
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