=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699762013
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HELISE SHERI SANDBORN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2005
-----------------------------------------------------
Last Update Date | 01/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7000 PEACHTREE DUNWOODY RD BLDG 6 STE 302
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30328-1655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-234-6089
-----------------------------------------------------
Fax | 678-579-9664
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7000 PEACHTREE DUNWOODY RD BLDG 6 STE 302
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30328-1655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-234-6089
-----------------------------------------------------
Fax | 678-579-9664
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 001151
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------