Healthcare Provider Details

I. General information

NPI: 1457927717
Provider Name (Legal Business Name): ORIEMA EWO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5835 CAMPBELLTON RD SW
ATLANTA GA
30331-8013
US

IV. Provider business mailing address

6530 WOODFORD RD
ATLANTA GA
30349-4528
US

V. Phone/Fax

Practice location:
  • Phone: 404-666-9261
  • Fax:
Mailing address:
  • Phone: 404-704-4742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC013391
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: