Healthcare Provider Details

I. General information

NPI: 1437276151
Provider Name (Legal Business Name): SUSAN B REID LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6111 PEACHTREE DUNWOODY RD NE BG. C
ATLANTA GA
30328-6049
US

IV. Provider business mailing address

6111-PEACHTREE-DUNWOODY RD BG. C, PEACHTREE-DUNWOODY SQ.
ATLANTA GA
30328
US

V. Phone/Fax

Practice location:
  • Phone: 770-396-0232
  • Fax: 770-399-0007
Mailing address:
  • Phone: 770-396-0232
  • Fax: 770-399-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1685
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: