Doctor Name: | MRS. TATIANA KISIL |
NPI Number: | 1053321687 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS |
License Number: | 003359 |
Business Practice Address: | 2450 Atlanta Hwy #801 Cumming, GA - 300408099 |
Business Phone Number: | 6784550083 |
Business Fax Number: | 6784550085 |
Mailing Address: | 5095 Winding Branch Dr, ATLANTA |
State: | GA |
Postal Code: | 303383901 |
Phone Number: | 7703900395 |
Fax Number: | 6784550085 |
NPI Enumeration Date: | 08/08/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 003359 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |