Healthcare Provider Details

I. General information

NPI: 1033267513
Provider Name (Legal Business Name): ANGIE LYNN HEATH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 PROSPECT PL
ALPHARETTA GA
30005-5467
US

IV. Provider business mailing address

5680 PEACHTREE PKWY B
PEACHTREE CORNERS GA
30092-2857
US

V. Phone/Fax

Practice location:
  • Phone: 770-807-2182
  • Fax:
Mailing address:
  • Phone: 770-807-2182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004444
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: