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General NPI Number Information
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NPI Number | 1720348188
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Entity Type | Individual
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Provider Name | MARCIA C HENNESSEY LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/20/2012
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 100 MARKET PLACE BLVD SUITE 201
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City | CARTERSVILLE
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State | GA
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Zip | 30121-8718
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Country | US
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Telephone | 706-625-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 204 PROFESSIONAL CT SE
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City | CALHOUN
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State | GA
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Zip | 30701-7020
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Country | US
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Telephone | 706-625-5900
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW004615
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | C0148
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License Number State | GA
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