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General NPI Number Information
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NPI Number | 1366766065
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Entity Type | Individual
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Provider Name | ROSSE NELLY MESA
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Gender | Female
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 2645 DALLAS HWY SW STE 230
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City | MARIETTA
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State | GA
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Zip | 30064-7578
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Country | US
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Telephone | 516-531-3821
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Fax |
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Provider Business Mailing Address
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Address Line | 2645 DALLAS HWY SW STE 230
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City | MARIETTA
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State | GA
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Zip | 30064-7578
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Country | US
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Telephone | 848-466-1880
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Fax | 848-466-1880
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001533
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001730
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License Number State | GA
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