| Sybil W Dudley Lcsw | |
|
50 Ford Way Ste 103 Richmond Hill GA 31324-4438 | |
| (912) 756-7136 | |
| (912) 756-7146 |
| Full Name | Sybil W Dudley Lcsw |
|---|---|
| Speciality | Social Worker |
| Location | 50 Ford Way Ste 103, Richmond Hill, Georgia |
| Authorized Official Name and Position | Sybil W Dudley (OWNER/THERAPIST) |
| Authorized Official Contact | 9127567136 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sybil W Dudley Lcsw Po Box 234 Richmond Hill GA 31324-0234 Ph: (912) 756-7136 | Sybil W Dudley Lcsw 50 Ford Way Ste 103 Richmond Hill GA 31324-4438 Ph: (912) 756-7136 |
| NPI Number | 1245498666 |
|---|---|
| Provider Enumeration Date | 06/02/2008 |
| Last Update Date | 01/16/2020 |
| Certification Date | 01/16/2020 |
| Medicare PECOS PAC ID | 2668530684 |
|---|---|
| Medicare Enrollment ID | O20081021000111 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245498666 | NPI | - | NPPES |
| 916944984A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CSW002924 (Georgia) | Primary |
| Provider Name | Sybil W Dudley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295784965 PECOS PAC ID: 6103826359 Enrollment ID: I20070111000365 |
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