Individual
IVY L. NALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, CAADC
Contact information
Practice address
3150 PERIMETER PKWY STE 110, AUGUSTA, GA 30909-5797
(706) 339-2854
Mailing address
2505 BELLEVUE AVE, AUGUSTA, GA 30904-4609
(706) 799-0296
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C0281
GA
1041C0700X
Clinical Social Worker
Primary
CSW007184
GA
Other
Enumeration date
06/17/2020
Last updated
01/03/2024
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