MEDICARE: SERI GOHDE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW004996	GA

General Provider Information

NPI Number	:	1487052213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERI GOHDE LCSW

Provider Business Mailing Address
First Line	:	125 E TRINITY PL
Second Line	:	SUITE 314
City	:	DECATUR
State	:	GA
Zip	:	30030-3360
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 E TRINITY PL
Second Line	:	SUITE 314
City	:	DECATUR
State	:	GA
Zip	:	30030-3360
Country	:	US
Telephone Number	:	678-632-3356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2014
Last Update Date	:	12/10/2014

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