Provider Demographics
NPI:1205911351
Name:HERTLE-JONES, CAROLA BARBARA (MSW)
Entity type:Individual
Prefix:MRS
First Name:CAROLA
Middle Name:BARBARA
Last Name:HERTLE-JONES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MIRRAMONT LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-8215
Mailing Address - Country:US
Mailing Address - Phone:770-517-3363
Mailing Address - Fax:770-517-3308
Practice Address - Street 1:131 MIRRAMONT LAKE DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8215
Practice Address - Country:US
Practice Address - Phone:770-517-3363
Practice Address - Fax:770-517-3308
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical