Healthcare Provider Details

I. General information

NPI: 1275447443
Provider Name (Legal Business Name): JOEL R SIEBENTRITT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 NANTAHALA AVE
ATHENS GA
30601-1937
US

IV. Provider business mailing address

264 NANTAHALA AVE
ATHENS GA
30601-1937
US

V. Phone/Fax

Practice location:
  • Phone: 571-438-0243
  • Fax:
Mailing address:
  • Phone: 571-438-0243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW002306
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: