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General NPI Number Information
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NPI Number | 1801919246
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Entity Type | Individual
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Provider Name | ALTA B EBLIN LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2931 PACES FERRY RD SE SUITE 1
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City | ATLANTA
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State | GA
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Zip | 30339-3732
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Country | US
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Telephone | 770-432-9750
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Fax |
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Provider Business Mailing Address
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Address Line | 2257 BRIANWOOD TRL
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City | DECATUR
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State | GA
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Zip | 30033-1719
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Country | US
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Telephone | 404-634-1791
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Fax |
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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 | 138
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License Number State | GA
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