Provider Demographics
NPI:1053639815
Name:PALMER, LAURIE D (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:D
Last Name:PALMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 MOUNTAIN BROOK RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8735
Mailing Address - Country:US
Mailing Address - Phone:770-345-2230
Mailing Address - Fax:
Practice Address - Street 1:3227 S CHEROKEE LN
Practice Address - Street 2:STE 1360
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7012
Practice Address - Country:US
Practice Address - Phone:404-545-1218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0041121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical