Provider Demographics
NPI:1700779998
Name:BELL, MAI-LAN QUIQUE
Entity type:Individual
Prefix:
First Name:MAI-LAN
Middle Name:QUIQUE
Last Name:BELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 CHALMERS DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-7401
Mailing Address - Country:US
Mailing Address - Phone:470-530-4673
Mailing Address - Fax:
Practice Address - Street 1:267 CHALMERS DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-7401
Practice Address - Country:US
Practice Address - Phone:470-530-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12192024-3R101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral