Provider Demographics
NPI:1366766065
Name:MESA, ROSSE NELLY
Entity type:Individual
Prefix:
First Name:ROSSE
Middle Name:NELLY
Last Name:MESA
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 1:2645 DALLAS HWY SW STE 230
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-7578
Mailing Address - Country:US
Mailing Address - Phone:848-466-1880
Mailing Address - Fax:848-466-1880
Practice Address - Street 1:2645 DALLAS HWY SW STE 230
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-7578
Practice Address - Country:US
Practice Address - Phone:516-531-3821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY001533106H00000X
GA001730106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health