Provider Demographics
NPI:1164659447
Name:CHADWICK, CAROL R (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:R
Last Name:CHADWICK
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 1:2506 SHADOWOOD PKWY SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2330
Mailing Address - Country:US
Mailing Address - Phone:850-221-1046
Mailing Address - Fax:
Practice Address - Street 1:2506 SHADOWOOD PKWY SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2330
Practice Address - Country:US
Practice Address - Phone:850-221-1046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0032981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical