| Ibml. Llc. | |
|
2365 Wall St Se Suite 200-05 Conyers GA 30013-2197 | |
| (866) 298-3447 | |
| (866) 261-5260 |
| Full Name | Ibml. Llc. |
|---|---|
| Speciality | Counselor - Professional |
| Location | 2365 Wall St Se, Conyers, Georgia |
| Authorized Official Name and Position | Mireille Etienne (PARTNER/THERAPIST) |
| Authorized Official Contact | 8662983447 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ibml. Llc. 1 W Court Sq Suite 750 Decatur GA 30030-2538 Ph: (866) 298-3447 | Ibml. Llc. 2365 Wall St Se Suite 200-05 Conyers GA 30013-2197 Ph: (866) 298-3447 |
| NPI Number | 1750559217 |
|---|---|
| Provider Enumeration Date | 02/18/2008 |
| Last Update Date | 02/14/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750559217 | NPI | - | NPPES |
| 11824149 | Other | GA | CAQH |
| 476557646A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC004290 (Georgia) | Primary |
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