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NPI Code Detail

MEDICARE: MRS. YASHICA MAXWELL LLMSW, LCSW, LICSW

MEDICARE: MRS. YASHICA MAXWELL LLMSW, LCSW, LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker6801103666MI

General Provider Information

NPI Number : 1023572682
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. YASHICA MAXWELL LLMSW, LCSW, LICSW
Provider Business Mailing Address
First Line : 4400 BROWNSVILLE RD STE 105
Second Line :
City : POWDER SPRINGS
State : GA
Zip : 30127-8902
Country : US
Telephone Number : 616-263-6075
Fax Number :
Provider Business Practice Location Address
First Line : 142 E MAUMEE ST STE 3
Second Line :
City : ADRIAN
State : MI
Zip : 49221-2735
Country : US
Telephone Number : 517-263-5810
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2019
Last Update Date : 01/15/2026

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