Individual
MS. MARISSA EZELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, RPT
Contact information
Practice address
11285 ELKINS RD UNIT K1, ROSWELL, GA 30076-1259
(678) 756-8240
Mailing address
1635 ADAIR BLVD, CUMMING, GA 30040-7825
(678) 756-8240
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW006017
GA
Other
Enumeration date
11/08/2013
Last updated
08/24/2020
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