Healthcare Provider Details

I. General information

NPI: 1417087826
Provider Name (Legal Business Name): DOROTHY JEAN REISS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 WINN WAY
DECATUR GA
30030-1707
US

IV. Provider business mailing address

455 WINN WAY
DECATUR GA
30030-1707
US

V. Phone/Fax

Practice location:
  • Phone: 404-508-7700
  • Fax: 404-508-7733
Mailing address:
  • Phone: 404-508-7700
  • Fax: 404-508-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW000219
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: