Individual
MS. MIRANDA L. FALLEN-BOBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, NCC
Contact information
Practice address
3729 MAIN ST, COLLEGE PARK, GA 30337-3544
(678) 559-4043
Mailing address
3729 MAIN ST, COLLEGE PARK, GA 30337-3544
(678) 559-4043
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
GA
101YM0800X
Mental Health Counselor
Primary
—
GA
101YP1600X
Pastoral Counselor
—
GA
101YP2500X
Professional Counselor
—
GA
Other
Enumeration date
08/27/2014
Last updated
03/03/2021
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