Provider Demographics
NPI:1376765388
Name:SHEIRLING, AZAM MOLOOK (LCSW)
Entity Type:Individual
Prefix:
First Name:AZAM
Middle Name:MOLOOK
Last Name:SHEIRLING
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 1:145 PRICE DRIVE WEST
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248
Mailing Address - Country:US
Mailing Address - Phone:770-914-2169
Mailing Address - Fax:
Practice Address - Street 1:139 HENRY PARKWAY
Practice Address - Street 2:HENRY COUNTY COUNSELING CENTER
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253
Practice Address - Country:US
Practice Address - Phone:770-898-7421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0010861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAR80086Medicare ID - Type UnspecifiedSOCIAL WORKER