Healthcare Provider Details

I. General information

NPI: 1588034086
Provider Name (Legal Business Name): SAGE WEATHERBY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2015
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 CHURCH ST
DECATUR GA
30030-1869
US

IV. Provider business mailing address

820 CHURCH ST
DECATUR GA
30030-1869
US

V. Phone/Fax

Practice location:
  • Phone: 770-367-0622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005605
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: