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Individual

MARIE CARMELLE JEANLOUIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MBA, BCCC

Contact information

Practice address
538 RUSSETT CT SW, MARIETTA, GA 30064-4644
(770) 895-5522
Mailing address
538 RUSSETT CT SW, MARIETTA, GA 30064-4644
(770) 895-5522

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
09122676
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
09122676
GA
Enumeration date
10/15/2012
Last updated
10/15/2012
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