Provider Demographics
NPI:1902598642
Name:POOLE, IMANI (LCSW)
Entity Type:Individual
Prefix:
First Name:IMANI
Middle Name:
Last Name:POOLE
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 1:176 BRICKHILL CIR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-4810
Mailing Address - Country:US
Mailing Address - Phone:919-638-4055
Mailing Address - Fax:
Practice Address - Street 1:176 BRICKHILL CIR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31407-4810
Practice Address - Country:US
Practice Address - Phone:919-638-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040151891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical