Individual
MRS. CONSUELA DELORES DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1040 BOULEVARD SE, ATLANTA, GA 30312-3811
(404) 441-7967
Mailing address
2423 CHEYENNE CT, DOUGLASVILLE, GA 30135-8113
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MSW003163
GA
Other
Enumeration date
05/22/2017
Last updated
05/22/2017
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