Healthcare Provider Details

I. General information

NPI: 1972919082
Provider Name (Legal Business Name): ARDRA NORMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2826 HILLCREEK DR
AUGUSTA GA
30909-5628
US

IV. Provider business mailing address

2826 HILLCREEK DR
AUGUSTA GA
30909-5628
US

V. Phone/Fax

Practice location:
  • Phone: 706-373-2696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004921
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: