Provider Demographics
NPI:1811325053
Name:CARRILLO, YESENIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:YESENIA
Middle Name:
Last Name:CARRILLO
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 1:9325 HUTCHESON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-2306
Mailing Address - Country:US
Mailing Address - Phone:917-582-9179
Mailing Address - Fax:
Practice Address - Street 1:9325 HUTCHESON FERRY RD
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:GA
Practice Address - Zip Code:30268-2306
Practice Address - Country:US
Practice Address - Phone:917-582-9179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-25
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0705251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical