Healthcare Provider Details

I. General information

NPI: 1629558879
Provider Name (Legal Business Name): SEASON FLORES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SHUGART RD
DALTON GA
30720-2467
US

IV. Provider business mailing address

105 AVALON DR
CALHOUN GA
30701-9434
US

V. Phone/Fax

Practice location:
  • Phone: 706-270-5100
  • Fax:
Mailing address:
  • Phone: 706-859-2079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW006539
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: