Provider Demographics
NPI:1437276151
Name:REID, SUSAN B (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:REID
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 1:6111-PEACHTREE-DUNWOODY RD
Mailing Address - Street 2:BG. C, PEACHTREE-DUNWOODY SQ.
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:770-396-0232
Mailing Address - Fax:770-399-0007
Practice Address - Street 1:6111 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:BG. C
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-6049
Practice Address - Country:US
Practice Address - Phone:770-396-0232
Practice Address - Fax:770-399-0007
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBBNBMedicare ID - Type Unspecified