Healthcare Provider Details

I. General information

NPI: 1417669979
Provider Name (Legal Business Name): KARMECIA L'AIME DELOACH M.ED/ST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6944 HIGHWAY 85 STE F
RIVERDALE GA
30274-2960
US

IV. Provider business mailing address

20 STALWICK DR
POOLER GA
31322-8254
US

V. Phone/Fax

Practice location:
  • Phone: 770-683-6946
  • Fax: 770-683-6946
Mailing address:
  • Phone: 706-741-6576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC009547
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: