Healthcare Provider Details

I. General information

NPI: 1730848961
Provider Name (Legal Business Name): MAGGIE ROSE VRANA NCC, APC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3516 COVINGTON HWY
DECATUR GA
30032-1850
US

IV. Provider business mailing address

2906 CATALINA DR
DECATUR GA
30032-3522
US

V. Phone/Fax

Practice location:
  • Phone: 404-308-8548
  • Fax:
Mailing address:
  • Phone: 423-255-4959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: