| Mir Behavioral Health Llc | |
|
6886 Main St Ste 215 Lithonia GA 30058-4508 | |
| (404) 759-3444 | |
| Not Available |
| Full Name | Mir Behavioral Health Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 6886 Main St, Lithonia, Georgia |
| Authorized Official Name and Position | Madinah I Ralston (OWNER) |
| Authorized Official Contact | 7707593444 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mir Behavioral Health Llc 1227 Rockbridge Rd Ste 208-185 Stone Mountain GA 30087-3064 Ph: () - | Mir Behavioral Health Llc 6886 Main St Ste 215 Lithonia GA 30058-4508 Ph: (404) 759-3444 |
| NPI Number | 1629359807 |
|---|---|
| Provider Enumeration Date | 09/01/2011 |
| Last Update Date | 09/01/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629359807 | NPI | - | NPPES |
| 127231218G | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY003079 (Georgia) | Primary |
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