Healthcare Provider Details

I. General information

NPI: 1346777679
Provider Name (Legal Business Name): TREENA RAWLINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 DUG GAP RD
DALTON GA
30720-5007
US

IV. Provider business mailing address

4178 ROYAL REGENCY CIR NW
KENNESAW GA
30144-6478
US

V. Phone/Fax

Practice location:
  • Phone: 770-688-4991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006062
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: