MEDICARE: BIANCA LATOYA HAROLD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW009882	GA

General Provider Information

NPI Number	:	1205786720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIANCA LATOYA HAROLD LCSW

Provider Business Mailing Address
First Line	:	PO BOX 748465
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8465
Country	:	US
Telephone Number	:	855-284-7483
Fax Number	:	617-807-0958

Provider Business Practice Location Address
First Line	:	1850 LAKE PARK DR SE STE 216
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-7642
Country	:	US
Telephone Number	:	229-800-9695
Fax Number	:	617-807-0958

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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