| Ilera Therapy Llc | |
|
300 Colonial Center Pkwy Ste 100n Roswell GA 30076-4892 | |
| (678) 664-8298 | |
| Not Available |
| Full Name | Ilera Therapy Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 300 Colonial Center Pkwy Ste 100n, Roswell, Georgia |
| Authorized Official Name and Position | Ashley Bonvillain (CEO) |
| Authorized Official Contact | 6786648298 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ilera Therapy Llc 100 Commerce Dr Unit 191 Tyrone GA 30290-8009 Ph: () - | Ilera Therapy Llc 300 Colonial Center Pkwy Ste 100n Roswell GA 30076-4892 Ph: (678) 664-8298 |
| NPI Number | 1275280604 |
|---|---|
| Provider Enumeration Date | 03/06/2022 |
| Last Update Date | 03/08/2022 |
| Certification Date | 03/08/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275280604 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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