Individual
DR. RENA M GLASS-DIXON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LCSW
Contact information
Practice address
990 IRIS DR SW STE 103, CONYERS, GA 30094-6602
(770) 369-9984
(770) 369-9984
Mailing address
PO BOX 82653, CONYERS, GA 30013-9439
(404) 388-7981
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW004345
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CSW004345
STATE OF GEORGIA CLINICAL SOCIAL WORKER
GA
Enumeration date
09/30/2018
Last updated
01/30/2020
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