Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | CSW004676 | GA |
NPI | 1003150996 |
---|---|
Provider Name | Lori Whitmire |
First Address | Athens, GA 30606-2135 |
Second Address | Athens, GA 30606-2135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2012 |
Last Update Date | 16/11/2012 |