Provider Demographics
NPI:1366789885
Name:BELLAMY, MIRIAM RUTH (LMFT)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:RUTH
Last Name:BELLAMY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 WOODSTOCK RD
Mailing Address - Street 2:STE 7150
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5616
Mailing Address - Country:US
Mailing Address - Phone:404-932-9320
Mailing Address - Fax:
Practice Address - Street 1:1905 WOODSTOCK RD
Practice Address - Street 2:STE 7150
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5616
Practice Address - Country:US
Practice Address - Phone:404-932-9320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0934106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist