Healthcare Provider Details

I. General information

NPI: 1447378971
Provider Name (Legal Business Name): MARIA L BEJACMAR-DIDIER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2385 WALL ST SE
CONYERS GA
30013-2187
US

IV. Provider business mailing address

2608 HIGH ST SW
CONYERS GA
30094-6843
US

V. Phone/Fax

Practice location:
  • Phone: 678-849-0324
  • Fax:
Mailing address:
  • Phone: 678-849-0324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003742
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: