Charmaine Veronica Mattocks, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW004754 Issued in GA

Practice address

7413 Gossamer St
Union City, GA 30291-6100

Phone

(404) 664-2381

NPI assigned

Jul 30, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1375142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634688000000",
    "number": "1346672532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660253",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787667253",
            "telephone_number": "512-649-2270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7413 GOSSAMER ST",
            "city": "UNION CITY",
            "state": "GA",
            "postal_code": "302916100",
            "telephone_number": "404-664-2381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTOCKS",
        "first_name": "CHARMAINE",
        "middle_name": "VERONICA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-07-30",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW004754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Union City, GA
• Providers in Union City, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.