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General NPI Number Information
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NPI Number | 1801287917
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Entity Type | Individual
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Provider Name | ALESIA R CHRISTIAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 3015 VETERANS PKWY S
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City | MOULTRIE
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State | GA
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Zip | 31788-6705
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Country | US
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Telephone | 229-873-6479
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Fax | 229-890-6777
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Provider Business Mailing Address
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Address Line | 392 SMITH RD
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City | CAIRO
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State | GA
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Zip | 39828-7403
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Country | US
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Telephone | 229-413-3697
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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 | CSW005186
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License Number State | GA
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