Provider Demographics
NPI:1407925464
Name:LEVINE, SUSAN A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:A
Last Name:LEVINE
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 1:8097 ROSWELL RD
Mailing Address - Street 2:BLDG B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-6159
Mailing Address - Country:US
Mailing Address - Phone:770-393-8806
Mailing Address - Fax:770-393-8812
Practice Address - Street 1:8097 ROSWELL RD
Practice Address - Street 2:BLDG B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-6159
Practice Address - Country:US
Practice Address - Phone:770-393-8806
Practice Address - Fax:770-393-8812
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0003491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical