Provider Demographics
NPI:1073758819
Name:JANTZER, OLGA V (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:V
Last Name:JANTZER
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 1:450 RIDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-7709
Mailing Address - Country:US
Mailing Address - Phone:770-716-1805
Mailing Address - Fax:
Practice Address - Street 1:3580 CAMERON PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7816
Practice Address - Country:US
Practice Address - Phone:678-565-6228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW003611041C0700X
FLSW39671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical