Provider Information for 1902104664
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SIYAMA DRAKE LPC
Sex: Female
NPI: 1902104664
Last Updated: 2011-03-04
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1902104664 | ||||||||
| Enumeration Date | 2011-03-04 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1900 THE EXCHANGE SE SUITE 420 ATLANTA, GA 30339-2022 United States Phone: 678-460-0345 | Fax:678-460-0350 | ||||||||
| Primary Practice Address | 1900 THE EXCHANGE SE SUITE 420 ATLANTA, GA 30339-2022 United States Phone: 678-460-0345 | Fax:678-460-0350 | ||||||||
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