Healthcare Provider Details

I. General information

NPI: 1770098766
Provider Name (Legal Business Name): MIESHA N RHODES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 01/10/2022
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8011 MALL PKWY
LITHONIA GA
30038-2543
US

IV. Provider business mailing address

3495 PIEDMONT RD NE NINE PIEDMONT CENTER
ATLANTA GA
30305-1717
US

V. Phone/Fax

Practice location:
  • Phone: 404-365-0966
  • Fax: 770-220-3705
Mailing address:
  • Phone: 404-364-7285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW006198
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: