Provider Demographics
NPI:1649317025
Name:POFF, MARILYN T (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:T
Last Name:POFF
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 1:504 DANCING FOX RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032
Mailing Address - Country:US
Mailing Address - Phone:404-378-0849
Mailing Address - Fax:404-373-9662
Practice Address - Street 1:14 EASTBROOK BEND
Practice Address - Street 2:SUITE 218
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269
Practice Address - Country:US
Practice Address - Phone:404-378-0849
Practice Address - Fax:404-373-9662
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0006661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical