Provider Demographics
NPI:1033475942
Name:SOCIAL WORK SUPERVISION, INC
Entity Type:Organization
Organization Name:SOCIAL WORK SUPERVISION, INC
Other - Org Name:MELISSA LESTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-313-7768
Mailing Address - Street 1:4219 BONAPARTE DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-2206
Mailing Address - Country:US
Mailing Address - Phone:770-313-7768
Mailing Address - Fax:
Practice Address - Street 1:621 NORTH AVE NE
Practice Address - Street 2:BUILDING E
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2857
Practice Address - Country:US
Practice Address - Phone:770-313-7768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0030821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1508929241OtherPERSONAL NPI 1508929241