| Mirror Image Group, Llc | |
|
285 S Perry St Lawrenceville GA 30046-4840 | |
| (404) 452-7752 | |
| Not Available |
| Full Name | Mirror Image Group, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 285 S Perry St, Lawrenceville, Georgia |
| Authorized Official Name and Position | Alison Rene Kahn (PRESIDENT) |
| Authorized Official Contact | 4044527752 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mirror Image Group, Llc 285 S Perry St Lawrenceville GA 30046-4840 Ph: (404) 452-7752 | Mirror Image Group, Llc 285 S Perry St Lawrenceville GA 30046-4840 Ph: (404) 452-7752 |
| NPI Number | 1275741639 |
|---|---|
| Provider Enumeration Date | 05/18/2007 |
| Last Update Date | 02/10/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275741639 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | APC000985 (Georgia) | Primary |
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