Healthcare Provider Details

I. General information

NPI: 1033608641
Provider Name (Legal Business Name): MIREILLE TERCIER WINN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8735 DUNWOODY PL # 10458
SANDY SPRINGS GA
30350-2995
US

IV. Provider business mailing address

PO BOX 1042
RED OAK GA
30272-1042
US

V. Phone/Fax

Practice location:
  • Phone: 229-946-4680
  • Fax:
Mailing address:
  • Phone: 229-946-4680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-419640
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License NumberCRC00045792
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: