Provider Demographics
NPI:1720348188
Name:HENNESSEY, MARCIA C (LCSW)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:C
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:C
Other - Last Name:HENNESSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:204 PROFESSIONAL CT SE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-7020
Mailing Address - Country:US
Mailing Address - Phone:706-625-5900
Mailing Address - Fax:
Practice Address - Street 1:100 MARKET PLACE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-8718
Practice Address - Country:US
Practice Address - Phone:706-625-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-20
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0046151041C0700X
GAC0148101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I805788OtherMEDICARE
GA003134331CMedicaid