Individual
JENNIFER TALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
180 MARTIN DR, CARROLLTON, GA 30117-2425
(770) 603-3406
Mailing address
7124 CHESTNUT LN, RIVERDALE, GA 30274-3336
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
CSW002893
GA
Other
Enumeration date
10/23/2013
Last updated
10/23/2013
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