| Wanda Devaughn, Lcsw, Pc | |
|
317 Alexander St Se Marietta GA 30060-2077 | |
| (770) 425-4488 | |
| (770) 425-8862 |
| Full Name | Wanda Devaughn, Lcsw, Pc |
|---|---|
| Speciality | Social Worker |
| Location | 317 Alexander St Se, Marietta, Georgia |
| Authorized Official Name and Position | Wanda Devaughn (PRESIDENT) |
| Authorized Official Contact | 7704254488 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wanda Devaughn, Lcsw, Pc 317 Alexander St Se Marietta GA 30060-2077 Ph: (770) 425-4488 | Wanda Devaughn, Lcsw, Pc 317 Alexander St Se Marietta GA 30060-2077 Ph: (770) 425-4488 |
| NPI Number | 1023264827 |
|---|---|
| Provider Enumeration Date | 08/12/2008 |
| Last Update Date | 08/12/2008 |
| Medicare PECOS PAC ID | 3476628942 |
|---|---|
| Medicare Enrollment ID | O20080818000638 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023264827 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CSW000605 (Georgia) | Primary |
| Provider Name | Wanda H Devaughn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336251545 PECOS PAC ID: 8224103791 Enrollment ID: I20080818000604 |
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