Black Swan Enterprises

NPI 1033556659 - Community/Behavioral Health - 251S00000X

NPI Details
NPI 1033556659
Enumeration Date 05/23/2013
Last Updated 06/12/2014
Entity Type Healthcare Provider
Active Over 3 years ago
Authorized Information
Name MIKAELA NICOLE MIKAELA
Position OWNER, LEAD THERAPIST
Phone (404) 832-0604
Fax
Practice Location
2801 BUFORD HWY NE
STE 501
ATLANTA GA, 30329-2149, US
Phone (404) 832-0604
Fax
Business Location
1313 OAK ST SW
ATLANTA GA, 30310-1653, US
Phone (678) 748-0128
Fax
Toxanomy
Taxonomy Code 251S00000X
License State Georgia
License Number LPC007304
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According to our database, Black Swan Enterprises NPI is 1033556659, taxonomy code is 251S00000X and license number is LPC007304, license state is located at Georgia. Black Swan Enterprises physically located at 2801 Buford Hwy Ne, Atlanta GA, 30329-2149. NPI Number 1033115704 has the healthcare provider type.

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1033556659 NPI number is provided on an as is basis without warranty of any kind. 1033556659 is maintained by the National Plan & Provider Enumeration System. The contents of Black Swan Enterprises are for informational purposes only.