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General NPI Number Information
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NPI Number | 1497014450
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Entity Type | Organization
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Legal Business Name | DOROTHY EBERHART LCSW, LLC
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 5605 GLENRIDGE DR NE SUITE 600
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City | ATLANTA
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State | GA
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Zip | 30342-1365
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Country | US
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Telephone | 770-367-4090
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Fax |
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Provider Business Mailing Address
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Address Line | 4577 VILLAGE DR
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City | DUNWOODY
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State | GA
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Zip | 30338-5741
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Country | US
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Telephone | 770-367-4090
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DOROTHY EBERHART
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Credential | LCSW
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Telephone | 770-367-4090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CSW003039
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License Number State | GA
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