Provider Demographics
NPI:1346672532
Name:MATTOCKS, CHARMAINE VERONICA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHARMAINE
Middle Name:VERONICA
Last Name:MATTOCKS
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:PO BOX 660253
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78766-7253
Mailing Address - Country:US
Mailing Address - Phone:512-649-2270
Mailing Address - Fax:
Practice Address - Street 1:7413 GOSSAMER ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-6100
Practice Address - Country:US
Practice Address - Phone:404-664-2381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0047541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical