Individual
MAXINE JEAN DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
10 PERIMETER SUMMIT BLVD NE UNIT 4408, BROOKHAVEN, GA 30319-1487
(404) 468-3284
(678) 309-1039
Mailing address
10 PERIMETER SUMMIT BLVD NE UNIT 4408, BROOKHAVEN, GA 30319-1487
(404) 468-3284
(678) 309-1039
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW005840
GA
Other
Enumeration date
01/05/2021
Last updated
01/05/2021
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