Individual
AQUARIUS S CARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1345 REDMOND CIR NW, ROME, GA 30165-1307
(910) 742-9243
Mailing address
83 ARMSTEAD DR, STOCKBRIDGE, GA 30281-3937
(678) 558-2467
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
007459
GA
Other
Enumeration date
06/11/2021
Last updated
06/11/2021
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