Provider Demographics
NPI:1265180897
Name:CROSSEN, MARK ANDREW (LMSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:CROSSEN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:MR
Other - First Name:MARK
Other - Middle Name:ANDREW
Other - Last Name:CROSSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1121 JOHNSON FERRY RD STE 450
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-5433
Mailing Address - Country:US
Mailing Address - Phone:770-694-6349
Mailing Address - Fax:
Practice Address - Street 1:1121 JOHNSON FERRY RD STE 450
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-5433
Practice Address - Country:US
Practice Address - Phone:770-694-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW009757104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker