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NPI Code Detail

MEDICARE: LIESL ENGELBRECHT NCC

MEDICARE: LIESL ENGELBRECHT NCC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1821829730
Entity Type Code : Individual
Provider Name (Legal Business Name) : LIESL ENGELBRECHT NCC
Provider Business Mailing Address
First Line : 2998 NURSERY RD SE
Second Line :
City : SMYRNA
State : GA
Zip : 30082-2130
Country : US
Telephone Number : 240-994-0269
Fax Number :
Provider Business Practice Location Address
First Line : 1640 POWERS FERRY RD SE BLDG 14-200
Second Line :
City : MARIETTA
State : GA
Zip : 30067-1459
Country : US
Telephone Number : 888-551-5168
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2024
Last Update Date : 08/12/2024

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