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General NPI Number Information
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NPI Number | 1710353156
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Entity Type | Organization
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Legal Business Name | SALLY H CLANIN, LCSW, LLC
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Dates
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Enumeration Date | 08/20/2015
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Last Update Date | 08/20/2015
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Provider Practice Location Address
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Address Line | 922 HIGHWAY 81 E STE 151
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City | MCDONOUGH
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State | GA
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Zip | 30252-2978
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Country | US
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Telephone | 828-989-0160
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Fax |
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Provider Business Mailing Address
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Address Line | 55 JONESBORO ST
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City | MCDONOUGH
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State | GA
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Zip | 30253-3164
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Country | US
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Telephone | 828-989-0160
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SALLY H. CLANIN
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Credential | LCSW
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Telephone | 828-989-0160
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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 | CSW004476
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License Number State | GA
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