Healthcare Provider Details

I. General information

NPI: 1497933469
Provider Name (Legal Business Name): NANCY B SCHIMP MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 COTTONWOOD STREET
CLAYTON GA
30525
US

IV. Provider business mailing address

PO BOX 1689 44 COTTONWOOD STREET
CLAYTON GA
30525
US

V. Phone/Fax

Practice location:
  • Phone: 706-782-0717
  • Fax: 706-782-5266
Mailing address:
  • Phone: 706-782-0717
  • Fax: 706-782-5266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCSW003765
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: