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General NPI Number Information
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NPI Number | 1386279917
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Entity Type | Individual
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Provider Name | KRISTEN LABELLA LMSW
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Gender | Female
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Dates
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Enumeration Date | 03/04/2020
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 1102 SMITH AVE STE K
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City | THOMASVILLE
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State | GA
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Zip | 31792-5740
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Country | US
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Telephone | 229-225-4335
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 SMITH AVE STE H
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City | THOMASVILLE
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State | GA
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Zip | 31792-5740
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Country | US
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Telephone |
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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 | MSW009316
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License Number State | GA
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