MEDICARE: MRS. JANICE MARIE WILEY 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	000583	GA

General Provider Information

NPI Number	:	1871597757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANICE MARIE WILEY LCSW

Provider Business Mailing Address
First Line	:	JANICE M WILEY LCSW
Second Line	:	160 CLAIREMONT AVE. SUITE 200
City	:	DECATUR
State	:	GA
Zip	:	30030-2456
Country	:	US
Telephone Number	:	404-371-0490
Fax Number	:	404-255-9780

Provider Business Practice Location Address
First Line	:	JANICE M WILEY LCSW
Second Line	:	160 CLAIREMONT AVE. SUITE 200
City	:	DECATUR
State	:	GA
Zip	:	30030-2456
Country	:	US
Telephone Number	:	404-371-0490
Fax Number	:	404-255-9780

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	04/24/2018

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