Healthcare Provider Details

I. General information

NPI: 1346164209
Provider Name (Legal Business Name): ISABELLA ANTAH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 PARKWAY LN STE 430
PEACHTREE CORNERS GA
30092-2832
US

IV. Provider business mailing address

516 WALTON GREEN WAY NW
KENNESAW GA
30144-5914
US

V. Phone/Fax

Practice location:
  • Phone: 912-215-5631
  • Fax:
Mailing address:
  • Phone: 912-215-5631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMSW012884
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: