Healthcare Provider Details

I. General information

NPI: 1184902272
Provider Name (Legal Business Name): ORISE CAREY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2011
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2795 MAIN ST W STE 20B
SNELLVILLE GA
30078-3164
US

IV. Provider business mailing address

3665 CLUB DR STE 107
DULUTH GA
30096-1806
US

V. Phone/Fax

Practice location:
  • Phone: 678-344-7836
  • Fax:
Mailing address:
  • Phone: 678-288-6550
  • Fax: 800-609-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW21028
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW005284
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: