Provider Demographics
NPI:1710353156
Name:SALLY H CLANIN, LCSW, LLC
Entity Type:Organization
Organization Name:SALLY H CLANIN, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:H
Authorized Official - Last Name:CLANIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:828-989-0160
Mailing Address - Street 1:55 JONESBORO ST
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3164
Mailing Address - Country:US
Mailing Address - Phone:828-989-0160
Mailing Address - Fax:
Practice Address - Street 1:922 HIGHWAY 81 E
Practice Address - Street 2:STE 151
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-2978
Practice Address - Country:US
Practice Address - Phone:828-989-0160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0044761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty