Individual
MS. GEORGIA FAYE KOUSHIAFES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW LCSW
Contact information
Practice address
604 W DODDS ST, BLOOMINGTON, IN 47403-4773
(812) 360-2869
Mailing address
604 W DODDS ST, BLOOMINGTON, IN 47403-4773
(812) 360-2869
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34003881A
IN
Other
Enumeration date
09/11/2021
Last updated
09/11/2021
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