Provider Demographics
NPI:1861699209
Name:PAYNE, MARCENIA LARENA (LMSW)
Entity type:Individual
Prefix:MS
First Name:MARCENIA
Middle Name:LARENA
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 LANGSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8051
Mailing Address - Country:US
Mailing Address - Phone:678-289-0713
Mailing Address - Fax:879-289-9582
Practice Address - Street 1:2380 DELOWE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-2154
Practice Address - Country:US
Practice Address - Phone:404-761-7915
Practice Address - Fax:404-761-2784
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW004203101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor