Healthcare Provider Details

I. General information

NPI: 1063913283
Provider Name (Legal Business Name): SUSAN JOY LEVY LMFT, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E PACES FERRY RD NE STE 201
ATLANTA GA
30305-3319
US

IV. Provider business mailing address

455 E PACES FERRY RD NE STE 201
ATLANTA GA
30305-3319
US

V. Phone/Fax

Practice location:
  • Phone: 404-234-0112
  • Fax: 404-264-1470
Mailing address:
  • Phone: 404-234-0112
  • Fax: 404-264-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number229
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number200
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: