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General NPI Number Information
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NPI Number | 1568904456
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Entity Type | Individual
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Provider Name | MONIEK SHANELL GARSIDE LCSW, MBA
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Gender | Female
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Dates
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Enumeration Date | 11/09/2016
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 2751 BUFORD HWY NE STE 700
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City | ATLANTA
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State | GA
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Zip | 30324-5510
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Country | US
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Telephone | 404-807-2770
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Fax | 404-829-2400
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Provider Business Mailing Address
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Address Line | PO BOX 871296
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-0033
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Country | US
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Telephone | 404-807-2770
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Fax | 404-829-2400
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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 | CSW005281
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License Number State | GA
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