Individual
MARYUM HASAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCAADC
Contact information
Practice address
122 CLAXTON CT, JONESBORO, GA 30238-7028
(404) 388-6114
Mailing address
122 CLAXTON CT, JONESBORO, GA 30238-7028
(404) 388-6114
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/21/2012
Last updated
03/21/2012
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