Individual
DALE MYRA TUSHMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
100 MARINERS DR STE D, KINGSLAND, GA 31548-6667
(912) 510-0669
(912) 510-0754
Mailing address
100 MARINERS DR STE D, KINGSLAND, GA 31548-6667
(912) 510-0669
(912) 510-0754
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW 001945
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003219987A
—
GA
Enumeration date
05/18/2006
Last updated
12/31/2019
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