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General NPI Number Information
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NPI Number | 1013527589
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Entity Type | Individual
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Provider Name | MYKIESHIA AYANIAH SERRIA SEIGLER
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Gender | Female
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Dates
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Enumeration Date | 08/08/2020
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Last Update Date | 08/08/2020
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Provider Practice Location Address
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Address Line | 6173 REDTOP LOOP
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City | FAIRBURN
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State | GA
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Zip | 30213-4421
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Country | US
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Telephone | 678-363-3562
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 OLDE SPRING TRL
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City | LITHIA SPRINGS
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State | GA
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Zip | 30122-2749
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Country | US
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Telephone | 678-362-3562
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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