Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | CSW 003265 | GA |
NPI | 1003021510 |
---|---|
Provider Name | Laura Carolyn Jalbert |
First Address | Marietta, GA 30062-8361 |
Second Address | Marietta, GA 30062-8361 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 02/03/2020 |