MEDICARE: MIKELA HALLMARK M.S., LMHC, 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1831452028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKELA HALLMARK M.S., LMHC, LPC

Provider Business Mailing Address
First Line	:	18 LENOX POINTE NE STE A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-7402
Country	:	US
Telephone Number	:	678-744-7347
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 LENOX POINTE NE STE A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-7402
Country	:	US
Telephone Number	:	678-744-7347
Fax Number	:

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

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	12/07/2017

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