Individual
MARCIA C HENNESSEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
100 MARKET PLACE BLVD, SUITE 201, CARTERSVILLE, GA 30121-8718
(706) 625-5900
Mailing address
204 PROFESSIONAL CT SE, CALHOUN, GA 30701-7020
(706) 625-5900
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C0148
GA
1041C0700X
Clinical Social Worker
Primary
CSW004615
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003134331C
—
GA
01
—
202I805788
MEDICARE
GA
Enumeration date
05/20/2012
Last updated
12/09/2014
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