Provider Demographics
NPI:1811147952
Name:NEWELL, MARY E (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:NEWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2362 BIRCH HOLLOW TRL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6335
Mailing Address - Country:US
Mailing Address - Phone:678-977-8619
Mailing Address - Fax:
Practice Address - Street 1:5435 SUGARLOAF PKWY STE 1104
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5700
Practice Address - Country:US
Practice Address - Phone:678-977-8619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW003959104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker