Provider Demographics
NPI:1861530453
Name:DENTON, MARY LEIGH SR (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:LEIGH
Last Name:DENTON
Suffix:SR
Gender:F
Credentials:LCSW
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1545
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30169-1545
Mailing Address - Country:US
Mailing Address - Phone:770-345-7149
Mailing Address - Fax:770-345-1277
Practice Address - Street 1:2920 MARIETTA HWY STE 8
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8212
Practice Address - Country:US
Practice Address - Phone:770-345-7149
Practice Address - Fax:770-345-1277
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA12351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBFJFMedicare ID - Type Unspecified