Provider Demographics
NPI:1760903652
Name:MARION, SAMUEL (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:MARION
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 1:115 E MAIN ST STE A1B-8L
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5727
Mailing Address - Country:US
Mailing Address - Phone:770-904-1761
Mailing Address - Fax:
Practice Address - Street 1:4482 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-7512
Practice Address - Country:US
Practice Address - Phone:770-904-1761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0061031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical