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General NPI Number Information
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NPI Number | 1164253423
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Entity Type | Individual
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Provider Name | ANSLEY MARIE BAIR
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Gender | Female
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Dates
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Enumeration Date | 08/09/2024
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 200 S CARROLL RD
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City | VILLA RICA
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State | GA
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Zip | 30180-2606
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Country | US
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Telephone | 678-941-3795
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Fax |
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Provider Business Mailing Address
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Address Line | 205 BELVA ST
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City | CARROLLTON
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State | GA
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Zip | 30117-2533
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Country | US
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Telephone | 770-262-9831
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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 | APC009169
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License Number State | GA
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