Basic Information
| Provider Information | |||||||||
| NPI: | 1851578736 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNIGHT | ||||||||
| FirstName: | MENTA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 CHATEAU CT SE | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301617238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062339023 | ||||||||
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| Practice Location | |||||||||
| Address1: | 43 CHATEAU CT SE | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301617238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062339023 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2008 | ||||||||
| LastUpdateDate: | 01/23/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC005125 | GA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.