Provider Demographics
NPI:1922466093
Name:MEJIA, GISELL
Entity Type:Individual
Prefix:
First Name:GISELL
Middle Name:
Last Name:MEJIA
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 1:6245 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-1806
Mailing Address - Country:US
Mailing Address - Phone:678-344-7836
Mailing Address - Fax:678-892-8575
Practice Address - Street 1:6245 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-1806
Practice Address - Country:US
Practice Address - Phone:678-481-0481
Practice Address - Fax:678-892-8575
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health