Healthcare Provider Details

I. General information

NPI: 1639990104
Provider Name (Legal Business Name): ANDI LONON OBRYAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 PIEDMONT RD NE STE 410
ATLANTA GA
30305-1717
US

IV. Provider business mailing address

5 ALBEMARLE DR NW
ATLANTA GA
30327-1856
US

V. Phone/Fax

Practice location:
  • Phone: 404-808-2084
  • Fax:
Mailing address:
  • Phone: 404-808-2084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005137
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: