| NPI | 1558731604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRA IHEME President 678-922-2834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: GA LPC002789) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: GA LPC006908) |
| 101YP2500X Counselor Professional (Licence: GA LPC005575) | |
| 101YP2500X Counselor Professional (Licence: GA LPC003902) | |
| 1041C0700X Social Worker Clinical (Licence: GA CSW005116) | |
| 207Q00000X Family Medicine (Licence: GA 69322) | |
| Enumeration Date | 2015-10-01 |
| Last Update Date | 2015-10-01 |