MEDICARE: ISMAIL RAHEEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC014810	GA

General Provider Information

NPI Number	:	1508454513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISMAIL RAHEEM

Provider Business Mailing Address
First Line	:	43 AMANDA DR
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-6057
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	43 AMANDA DR
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-6057
Country	:	US
Telephone Number	:	706-409-6280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2021
Last Update Date	:	05/14/2025

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Directions to “ ISMAIL RAHEEM ” Practice Location

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