Provider Demographics
NPI:1356500953
Name:DRISCOLL, WILLIAM JASON (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JASON
Last Name:DRISCOLL
Suffix:
Gender:M
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 40348
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92164-0348
Mailing Address - Country:US
Mailing Address - Phone:619-925-1474
Mailing Address - Fax:
Practice Address - Street 1:1050 CROWN POINTE PKWY
Practice Address - Street 2:STE.295
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-7707
Practice Address - Country:US
Practice Address - Phone:866-325-5434
Practice Address - Fax:866-325-5340
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0039421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW00392OtherSTATE LICENSE