Provider Demographics
NPI:1720739378
Name:DRIGGERS, MARIAH CARAWAY (AMFT)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:CARAWAY
Last Name:DRIGGERS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 LITTLE FARM LN
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2628
Mailing Address - Country:US
Mailing Address - Phone:912-293-7971
Mailing Address - Fax:
Practice Address - Street 1:404 CORDER RD STE 100
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7196
Practice Address - Country:US
Practice Address - Phone:478-322-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000774106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty