Individual
MRS. JODI ELLEN FORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
122 CHERRY ST NE, MARIETTA, GA 30060-7206
(404) 272-4261
(770) 422-2302
Mailing address
122 CHERRY ST NE, MARIETTA, GA 30060-7206
(404) 272-4261
(770) 422-2302
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2835
GA
Other
Enumeration date
12/27/2006
Last updated
07/08/2007
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