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General NPI Number Information
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NPI Number | 1023327525
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Entity Type | Individual
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Provider Name | IJUANA LANDRY LAPC
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Gender | Female
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 317 W HILL ST 205
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City | DECATUR
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State | GA
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Zip | 30030-4367
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Country | US
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Telephone | 404-314-5259
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Fax |
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Provider Business Mailing Address
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Address Line | 3550 CENTERVILLE HWY 107 #120
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City | SNELLVILLE
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State | GA
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Zip | 30039-4133
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Country | US
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Telephone | 404-314-5259
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | APC002276
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License Number State | GA
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