Provider Demographics
NPI:1083271670
Name:MAPP, IMONI D
Entity Type:Individual
Prefix:
First Name:IMONI
Middle Name:D
Last Name:MAPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 FOX GLOVE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-7336
Mailing Address - Country:US
Mailing Address - Phone:678-230-3147
Mailing Address - Fax:
Practice Address - Street 1:180 FOX GLOVE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-7336
Practice Address - Country:US
Practice Address - Phone:678-230-3147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-21-52268103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst