Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | MSW007467 | GA |
NPI | 1003382003 |
---|---|
Provider Name | Ansley Maurer |
First Address | Valdosta, GA 31602-2415 |
Second Address | Valdosta, GA 31602-5910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2018 |
Last Update Date | 17/10/2018 |