Provider Demographics
NPI:1841006954
Name:MARS, MARILISSE IAKOVOU (MS, LPC, CST)
Entity type:Individual
Prefix:MS
First Name:MARILISSE
Middle Name:IAKOVOU
Last Name:MARS
Suffix:
Gender:F
Credentials:MS, LPC, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2456 SUNSET DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1945
Mailing Address - Country:US
Mailing Address - Phone:706-255-0180
Mailing Address - Fax:
Practice Address - Street 1:2456 SUNSET DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-1945
Practice Address - Country:US
Practice Address - Phone:706-255-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009836101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional