Doctor Name: | MRS. ALYSSA A THAXTON |
NPI Number: | 1043544356 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW, CAC II |
License Number: | CWS004742 |
Business Practice Address: | 701 Charles Gilman Jr Ave Ste A Kingsland, GA - 315485662 |
Business Phone Number: | 9125760401 |
Business Fax Number: | |
Mailing Address: | 701 Charles Gilman Jr Ave Ste A, KINGSLAND |
State: | GA |
Postal Code: | 315485662 |
Phone Number: | 9125760401 |
Fax Number: | |
NPI Enumeration Date: | 09/21/2009 |
NPI Last Update Date: | 12/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | CWS004742 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |