Individual
MARY KATHLEEN WEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, INC
Contact information
Practice address
201 COVE RD, JASPER, GA 30143-1356
(706) 253-9515
(706) 253-9516
Mailing address
201 COVE RD, JASPER, GA 30143-1356
(706) 253-9515
(706) 253-9516
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1362
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
065545668A
—
GA
05
—
939149656A
—
GA
Enumeration date
02/13/2006
Last updated
10/17/2022
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