Most Relevant Information
Provider Data
| NPI Number: | 1003578253 |
| Provider Name: | MARY ELIZABETH KRUSAC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | LMSW008594 |
Most Important Dates
| Enumeration Date: | 10/05/2021 |
| Last Updated: | 10/05/2021 |
Provider Practice Location
118 BIRCH RIVER CT
DALLAS
GA
301325575
Practice Location Phone/Fax
| Phone: | 6787448417 |
| Fax: |
Provider Mailing Location
118 BIRCH RIVER CT
DALLAS
GA
301325575
Provider Mailing Phone/Fax
| Phone: | 6787448417 |
| Fax: |