Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003230046 |
---|---|
Provider Name | Ameleo D Manuel |
First Address | Snellville, GA 30039-6170 |
Second Address | Lilburn, GA 30047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2014 |
Last Update Date | 22/05/2019 |