Provider Demographics
NPI:1174148951
Name:EARLY, MARY MORRELL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MORRELL
Last Name:EARLY
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 1:9250 HUTCHESON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-2336
Mailing Address - Country:US
Mailing Address - Phone:770-463-3344
Mailing Address - Fax:
Practice Address - Street 1:9250 HUTCHESON FERRY RD
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:GA
Practice Address - Zip Code:30268-2336
Practice Address - Country:US
Practice Address - Phone:770-463-3344
Practice Address - Fax:770-463-3301
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0025081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical