Individual
PERRY MALCOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
250 NORTH AVE, ATHENS, GA 30601-2244
(706) 389-6789
Mailing address
250 NORTH AVE, ATHENS, GA 30601-2244
(706) 389-6789
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW002504
GA
Other
Enumeration date
05/28/2013
Last updated
01/23/2015
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