Individual
KATHLEEN DEAL TATUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
296 TURPENTINE CIR, JESUP, GA 31545-2574
(912) 424-6134
Mailing address
296 TURPENTINE CIR, JESUP, GA 31545-2574
(912) 424-6134
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW008165
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CSW008165
STATE LICENSE
GA
Enumeration date
03/15/2019
Last updated
07/16/2024
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