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Organization

LISA MUSTILLO PSYCHOTHERAPY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LISA MUSTILLO LCSW (LICENSED CLINICAL SOCIAL WORKER)
(917) 992-7896
Entity
Organization

Contact information

Practice address
1301 SHILOH RD NW STE 860, KENNESAW, GA 30144-7174
(917) 992-7896
Mailing address
180 MONTGOMERY ST NE, MARIETTA, GA 30060-1440
(917) 992-7896

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary

Other

Enumeration date
04/21/2022
Last updated
08/09/2022
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