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General NPI Number Information
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NPI Number | 1861699209
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Entity Type | Individual
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Provider Name | MARCENIA LARENA PAYNE LMSW
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Gender | Female
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2380 DELOWE DR SUITE 1
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City | EAST POINT
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State | GA
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Zip | 30344-2154
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Country | US
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Telephone | 404-761-7915
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Fax | 404-761-2784
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Provider Business Mailing Address
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Address Line | 399 LANGSHIRE DR
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City | MCDONOUGH
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State | GA
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Zip | 30253-8051
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Country | US
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Telephone | 678-289-0713
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Fax | 879-289-9582
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MSW004203
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License Number State | GA
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