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General NPI Number Information
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NPI Number | 1346611423
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Entity Type | Organization
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Legal Business Name | STEVEN R.KILGORE, LCSW
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 617 PARKSIDE VILLAGE WAY NW
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City | MARIETTA
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State | GA
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Zip | 30060-7957
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Country | US
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Telephone | 770-514-1657
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Fax |
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Provider Business Mailing Address
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Address Line | 617 PARKSIDE VILLAGE WAY NW
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City | MARIETTA
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State | GA
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Zip | 30060-7957
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Country | US
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Telephone | 770-514-1657
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KATHY A. KILGORE
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Credential |
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Telephone | 404-402-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW001094
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License Number State | GA
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