Healthcare Provider Details

I. General information

NPI: 1831415744
Provider Name (Legal Business Name): VANESSA HEBERT, LCSW, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2993 PIEDMONT RD NE
ATLANTA GA
30305-2750
US

IV. Provider business mailing address

1110 VININGS GROVE WAY SE
SMYRNA GA
30082-4759
US

V. Phone/Fax

Practice location:
  • Phone: 404-219-7500
  • Fax:
Mailing address:
  • Phone: 404-219-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003741
License Number StateGA

VIII. Authorized Official

Name: VANESSA HEBERT
Title or Position: CEO
Credential: LCSW
Phone: 404-219-7500