Individual
DONNA MARIE MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
501 MIZE ST, LA FAYETTE, GA 30728-3346
(706) 639-5634
Mailing address
501 MIZE ST, LA FAYETTE, GA 30728-3346
(706) 639-5634
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
MSW006463
GA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
10/10/2014
Last updated
10/19/2015
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