Individual
DELORES DEANNE LISTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
112 N COLLEGE ST, STATESBORO, GA 30458-5309
(912) 536-1164
Mailing address
313 PALOMINO PATH, STATESBORO, GA 30458-8712
(912) 536-1164
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW006312
GA
Other
Enumeration date
04/10/2018
Last updated
04/10/2018
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