Organization
PORT OF PEACE COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIE-VIOLENE MERTILUS LCSW (THERAPIST)
(404) 291-8931
Entity
Organization
Contact information
Practice address
8305 OFFICE PARK DR, B, DOUGLASVILLE, GA 30134-6935
(404) 291-8931
Mailing address
PO BOX 1262, LITHIA SPRINGS, GA 30122-1165
(404) 291-8931
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
CSW004124
GA
Other
Enumeration date
01/12/2011
Last updated
01/12/2011
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