Provider Demographics
NPI:1033267513
Name:HEATH, ANGIE LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:LYNN
Last Name:HEATH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5680 PEACHTREE PKWY B
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2857
Mailing Address - Country:US
Mailing Address - Phone:770-807-2182
Mailing Address - Fax:
Practice Address - Street 1:390 PROSPECT PL
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-5467
Practice Address - Country:US
Practice Address - Phone:770-807-2182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0044441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC133EFOtherBCBS