Provider Demographics
NPI:1124783659
Name:ALBERTSON, MARY CAROLINE (EDD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:CAROLINE
Last Name:ALBERTSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 DENE DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-6349
Mailing Address - Country:US
Mailing Address - Phone:678-670-9055
Mailing Address - Fax:
Practice Address - Street 1:158 DENE DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6349
Practice Address - Country:US
Practice Address - Phone:678-670-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-31
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional