Provider Demographics
NPI:1659902666
Name:DOE, EDMONIA SIANNEH (MED, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:EDMONIA
Middle Name:SIANNEH
Last Name:DOE
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3343 PEACHTREE RD NE STE 145-1685
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1085
Mailing Address - Country:US
Mailing Address - Phone:470-222-3671
Mailing Address - Fax:
Practice Address - Street 1:3343 PEACHTREE RD NE STE 145-1685
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1085
Practice Address - Country:US
Practice Address - Phone:470-222-3671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013939101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional