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General NPI Number Information
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NPI Number | 1003502428
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Entity Type | Individual
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Provider Name | MARILYN ASHLEIGH TRUDEAU-WALLS LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 2727 PACES FERRY RD SE STE 260
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City | ATLANTA
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State | GA
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Zip | 30339-4053
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Country | US
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Telephone | 678-758-0616
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Fax |
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Provider Business Mailing Address
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Address Line | 1103 PARK BRG
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City | ACWORTH
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State | GA
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Zip | 30101-7212
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Country | US
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Telephone | 678-575-8384
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW009533
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License Number State | GA
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