MEDICARE: MRS. TRAKEETA PATTERSON 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	CSW006633	GA

General Provider Information

NPI Number	:	1598181901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRAKEETA PATTERSON LCSW

Provider Business Mailing Address
First Line	:	618 ASSOLAS CT
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-2497
Country	:	US
Telephone Number	:	912-398-4914
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 NORMAN BERRY DR STE 255
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-5102
Country	:	US
Telephone Number	:	404-386-1920
Fax Number	:

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

Provider Enumeration Date	:	03/10/2014
Last Update Date	:	07/15/2023

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