| Carolyn Minor Lcsw, Inc | |
|
175 Langley Dr Ste B1 Lawrenceville GA 30046-6929 | |
| (770) 995-7789 | |
| (770) 995-0171 |
| Full Name | Carolyn Minor Lcsw, Inc |
|---|---|
| Speciality | Social Worker |
| Location | 175 Langley Dr, Lawrenceville, Georgia |
| Authorized Official Name and Position | Carolyn Minor (OWNER) |
| Authorized Official Contact | 7709957789 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carolyn Minor Lcsw, Inc 175 Langley Dr Ste B1 Lawrenceville GA 30046-6929 Ph: (770) 995-7789 | Carolyn Minor Lcsw, Inc 175 Langley Dr Ste B1 Lawrenceville GA 30046-6929 Ph: (770) 995-7789 |
| NPI Number | 1053738294 |
|---|---|
| Provider Enumeration Date | 03/26/2014 |
| Last Update Date | 03/26/2014 |
| Medicare PECOS PAC ID | 6406294743 |
|---|---|
| Medicare Enrollment ID | O20240404003094 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053738294 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CSW001499 (Georgia) | Primary |
| Provider Name | Carolyn M Minor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285791129 PECOS PAC ID: 1052212941 Enrollment ID: I20040114000594 |
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