Mirror Image Group, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

APC000985 Issued in GA

Legal business name

MIRROR IMAGE GROUP, LLC

Practice address

285 S Perry St
Lawrenceville, GA 30046-4840

Phone

(404) 452-7752

NPI assigned

May 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alison Rene Kahn

Title

President

Phone

(404) 452-7752

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455062400000",
    "number": "1275741639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 S PERRY ST",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464840",
            "telephone_number": "404-452-7752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 S PERRY ST",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464840",
            "telephone_number": "404-452-7752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRROR IMAGE GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2016-02-10",
        "status": "A",
        "authorized_official_last_name": "KAHN",
        "authorized_official_first_name": "ALISON",
        "authorized_official_middle_name": "RENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-452-7752"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "APC000985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.