Basic Information
| Provider Information | |||||||||
| NPI: | 1093299356 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERRIN | ||||||||
| FirstName: | NATASHA | ||||||||
| MiddleName: | WILLIAMS | ||||||||
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| Credential: | LSCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6959 HACKLEBARNEY RD | ||||||||
| Address2: | |||||||||
| City: | BLACKSHEAR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315164692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126701299 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1007 MARY ST | ||||||||
| Address2: | |||||||||
| City: | WAYCROSS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315033823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124497100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2018 | ||||||||
| LastUpdateDate: | 02/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW006543 | GA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.