Individual
CARL ANTHONY WARDLAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
508 DONOVAN ST, VIDALIA, GA 30474-3149
(912) 537-9280
(912) 537-6289
Mailing address
PO BOX 178, VIDALIA, GA 30475-0178
(912) 537-9280
(912) 537-6289
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC005881
GA
Other
Enumeration date
02/17/2010
Last updated
02/17/2010
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