Healthcare Provider Details

I. General information

NPI: 1063974087
Provider Name (Legal Business Name): AISLING MOHINI MANISON MT-BC, LPMT, NMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 MOUNT VERNON RD
ATLANTA GA
30338-4673
US

IV. Provider business mailing address

1980 MOUNT VERNON RD
ATLANTA GA
30338-4673
US

V. Phone/Fax

Practice location:
  • Phone: 678-977-5513
  • Fax:
Mailing address:
  • Phone: 678-977-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: