Healthcare Provider Details

I. General information

NPI: 1790252443
Provider Name (Legal Business Name): REBECCA AARON MAMFT, LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6111 PEACHTREE DUNWOODY RD STE C101
ATLANTA GA
30328-4588
US

IV. Provider business mailing address

6111 PEACHTREE DUNWOODY RD STE C101
ATLANTA GA
30328-4588
US

V. Phone/Fax

Practice location:
  • Phone: 770-396-0232
  • Fax:
Mailing address:
  • Phone: 770-396-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC006644
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: