Healthcare Provider Details

I. General information

NPI: 1376082461
Provider Name (Legal Business Name): ALFIYA JAMES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 OLD NORCROSS RD STE 400
LAWRENCEVILLE GA
30044-8804
US

IV. Provider business mailing address

4255 WADE GREEN RD NW STE 414
KENNESAW GA
30144-1762
US

V. Phone/Fax

Practice location:
  • Phone: 678-213-2194
  • Fax: 678-922-7767
Mailing address:
  • Phone: 678-213-2194
  • Fax: 678-922-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW005761
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005761
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: