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General NPI Number Information
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NPI Number | 1750559217
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Entity Type | Organization
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Legal Business Name | INTEGRATING BODY MIND AND LIFE, LLC
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Dates
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Enumeration Date | 02/18/2008
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 2302 PARKLAKE DRIVE NE SUITE 425
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City | ATLANTA
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State | GA
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Zip | 30345-2966
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Country | US
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Telephone | 678-612-5587
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Fax | 866-261-5260
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Provider Business Mailing Address
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Address Line | 2302 PARKLAKE DRIVE NE SUITE 425
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City | ATLANTA
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State | GA
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Zip | 30345-2966
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Country | US
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Telephone | 678-612-5587
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Fax | 866-261-5260
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Authorized Official
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Title or Position | OWNER
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Name | MS. MIREILLE ETIENNE
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Credential | LPC, LMHC
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Telephone | 678-612-5587
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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 |
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License Number State |
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