MEDICARE: EDMONIA SIANNEH DOE M.ED, NCC, LPC

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	101YP2500X	Professional Counselor	LPC013939	GA

General Provider Information

NPI Number	:	1659902666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMONIA SIANNEH DOE M.ED, NCC, LPC

Provider Business Mailing Address
First Line	:	3343 PEACHTREE RD NE STE 145-1685
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1085
Country	:	US
Telephone Number	:	470-222-3671
Fax Number	:

Provider Business Practice Location Address
First Line	:	3343 PEACHTREE RD NE STE 145-1685
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1085
Country	:	US
Telephone Number	:	470-222-3671
Fax Number	:

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

Provider Enumeration Date	:	01/29/2020
Last Update Date	:	07/03/2023

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