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General NPI Number Information
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NPI Number | 1215285028
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Entity Type | Individual
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Provider Name | BRIAN AUSTIN TEAL LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 07/21/2023
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Provider Practice Location Address
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Address Line | 1441 WOODMONT LN NW STE 1988
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City | ATLANTA
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State | GA
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Zip | 30318-2866
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Country | US
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Telephone | 901-604-7463
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 WOODMONT LN NW STE 1988
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City | ATLANTA
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State | GA
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Zip | 30318-2866
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Country | US
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Telephone | 901-563-8565
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Fax | 678-974-0228
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW006390
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License Number State | GA
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