Individual
JILL LEVEY WAXMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
105 ARNOLD MILL RD, WOODSTOCK, GA 30188-5027
(770) 926-0016
(770) 926-0969
Mailing address
1540 HEATH LN, MARIETTA, GA 30062-5901
(770) 833-0885
(770) 565-7522
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY002824
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
893674432A
—
GA
Enumeration date
05/11/2006
Last updated
07/08/2007
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