Provider Demographics
NPI:1316027931
Name:MAULDIN, ELIZABETH HARMAN (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HARMAN
Last Name:MAULDIN
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 1:11503 BIG CANOE
Mailing Address - Street 2:
Mailing Address - City:BIG CANOE
Mailing Address - State:GA
Mailing Address - Zip Code:30143-5113
Mailing Address - Country:US
Mailing Address - Phone:404-281-1867
Mailing Address - Fax:706-579-2593
Practice Address - Street 1:11503 BIG CANOE
Practice Address - Street 2:
Practice Address - City:BIG CANOE
Practice Address - State:GA
Practice Address - Zip Code:30143-5113
Practice Address - Country:US
Practice Address - Phone:404-281-1867
Practice Address - Fax:706-579-2593
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0001931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
62-46919OtherPROV # UNITED HEALTHCARE
0004318183Medicare UPIN
GA80BBBBNTMedicare ID - Type Unspecified