Individual
MS. JUDITH LOUDON DERRISO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
308 COLISEUM DR, SUITE 120, MACON, GA 31217-3865
(478) 745-6130
(478) 745-4443
Mailing address
1835 SAVOY DR, SUITE 300, ATLANTA, GA 30341-1072
(770) 495-3396
(770) 495-2307
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
426
GA
Other
Enumeration date
10/21/2005
Last updated
02/11/2010
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