MS. MIRANDA L. FALLEN-BOBO (NPI# 1821498809) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821498809 |
| Entity Type | Individual |
| Full Name | MS. MIRANDA L. FALLEN-BOBO |
| Credential | LAPC, NCC |
| Practice Address |
1620 Sugar Plum Dr Sw Conyers GA 30094-6805 |
| Mailing Address |
Po Box 83390 Conyers GA 30013-9444 |
| Practice Telephone | 6785594043 |
| Mailing Telephone | 6785594043 |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2015-07-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | GA | Behavioral Health & Social Service Providers | |
| N | 101YM0800X |
Counselor Specialization: Mental Health |
GA | Behavioral Health & Social Service Providers | |
| N | 101YP1600X |
Counselor Specialization: Pastoral |
GA | Behavioral Health & Social Service Providers |
| Street Address |
1620 SUGAR PLUM DR SW |
| City | CONYERS |
| State | GA |
| Zip Code | 30094-6805 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164029054 | Darlene Fletcher | Counselor | 827 St. Clair Dr., Conyers, GA 30094 | 2020-10-05 |
| 1194363366 | Clara A Matthews | Physician Assistant | 1930 Windsor Creek Drive Sw, Conyers, GA 30094 | 2019-12-18 |
| 1659838571 | Sensitive Home Care Agency Inc. | PACE Provider Organization | 2225 Morning Dew, Conyers, GA 30094 | 2019-02-27 |
| 1679097992 | Sheira Dennis | Case Management | 3828 Martingale Dr Se, Conyers, GA 30094 | 2017-07-28 |
| 1730571399 | Wellness and Trauma Recovery Center | Counselor | 1775 Parker Rd. Building C, Suite 210, Conyers, GA 30094 | 2015-02-19 |
| 1760870612 | Michael Terrell | Technician/Technologist | 806 Cambridge Creek Dr, Conyers, GA 30094 | 2014-12-30 |
| 1538567466 | Jennifer Angela Johnson | Registered Nurse | 2240 Wren Rd Se, Conyers, GA 30094 | 2014-12-09 |
| 1225445208 | Wanda Marcella Rainey-reed | Counselor | 1453 Klondike Rd Sw Ste D, Conyers, GA 30094 | 2014-07-22 |
| 1508155268 | Nicklaus Trent Rice | Obstetrics & Gynecology | 2750 Owens Dr, Conyers, GA 30094 | 2011-04-04 |
| 1720219660 | Candace Alexander | Dentist | 863 Flat Shoals Rd Se, Suite C #220, Conyers, GA 30094 | 2009-07-27 |
| Find all providers in zip 30094 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871131813 | Ravik Foundation Inc. | Counselor | 1343 Business Center Dr Sw Ste B, Conyers, GA 30094-6609 | 2019-12-19 |
| 1033672191 | Dandrea R Sanders | Counselor | 1780b Southgate Ln Se, Conyers, GA 30013-2337 | 2019-04-07 |
| 1558879528 | Elva F Sajna | Counselor | 1407 Chelsea Downs Ln Ne, Conyers, GA 30013-5711 | 2018-01-12 |
| 1043660251 | Debra Lavette Hanson | Counselor | 3204 Quincey Xing, Conyers, GA 30013-6385 | 2016-06-18 |
| 1669847331 | Karen Williams | Counselor | 1414 Fall River Dr, Conyers, GA 30013-2992 | 2015-12-07 |
| 1386081073 | Lashay Taylor | Counselor | 754 Shoreline Trl Se, Conyers, GA 30094-2650 | 2013-06-04 |
| 1932468733 | Leslie Anne Styles | Counselor | 970 North Milstead Ave, Conyers, GA 30012 | 2012-05-14 |
| 1144528787 | Paula L. Christian-stallworth | Counselor | 343 Salem Gate Drive Se, Suite 101, Conyers, GA 30013-1783 | 2011-03-07 |
| 1053638668 | Aliyah Kindell | Counselor | 2047 Gees Mill Rd Ne Ste 222, Conyers, GA 30013-1361 | 2010-04-23 |
| 1457520660 | Mtbm Global Rehabilitation | Counselor | 2890a Ga Hwy 212, Suite 239, Conyers, GA 30094 | 2008-02-22 |
| Find all providers in CONYERS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.