Provider Demographics
NPI:1013527589
Name:SEIGLER, MYKIESHIA AYANIAH SERRIA
Entity type:Individual
Prefix:
First Name:MYKIESHIA
Middle Name:AYANIAH SERRIA
Last Name:SEIGLER
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 1:1620 OLDE SPRING TRL
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-2749
Mailing Address - Country:US
Mailing Address - Phone:678-362-3562
Mailing Address - Fax:
Practice Address - Street 1:6173 REDTOP LOOP
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-4421
Practice Address - Country:US
Practice Address - Phone:678-363-3562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor