Provider Demographics
NPI:1114349990
Name:CORREA-SANCHEZ, MAIRA
Entity Type:Individual
Prefix:
First Name:MAIRA
Middle Name:
Last Name:CORREA-SANCHEZ
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 1:2302 PARKLAKE DR NE STE 350
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2918
Mailing Address - Country:US
Mailing Address - Phone:770-621-0469
Mailing Address - Fax:770-621-0466
Practice Address - Street 1:2302 PARKLAKE DR NE STE 350
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2918
Practice Address - Country:US
Practice Address - Phone:770-621-0469
Practice Address - Fax:770-621-0466
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health