Provider Demographics
NPI:1053560748
Name:OSBORNE, MARLA MICHELE (BS IN SOCIAL WORK)
Entity type:Individual
Prefix:MS
First Name:MARLA
Middle Name:MICHELE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:BS IN SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:122 GORDON COMMERCIAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-5754
Mailing Address - Country:US
Mailing Address - Phone:706-845-4035
Mailing Address - Fax:706-845-4222
Practice Address - Street 1:122 GORDON COMMERCIAL DR STE A
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-5754
Practice Address - Country:US
Practice Address - Phone:706-845-4035
Practice Address - Fax:706-845-4222
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker