Healthcare Provider Details

I. General information

NPI: 1528698982
Provider Name (Legal Business Name): PAULA ROYANNA OKORO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 HAW CREEK CIR STE 403
CUMMING GA
30041-6567
US

IV. Provider business mailing address

3781 MENLOE WAY
SNELLVILLE GA
30039-5953
US

V. Phone/Fax

Practice location:
  • Phone: 404-955-6062
  • Fax:
Mailing address:
  • Phone: 404-955-6062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW006914
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: