Individual
MARY LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
1401 HOSEA WILLIAMS DR SE, ATLANTA, GA 30317-1703
(404) 373-6614
Mailing address
1353 GEORGE W BRUMLEY WAY SE, ATLANTA, GA 30317-1743
(404) 373-6614
(404) 373-2926
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW007041
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003244836A
—
GA
Enumeration date
07/21/2017
Last updated
07/16/2021
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