Provider Demographics
NPI:1508358169
Name:MEJIAS, BETSY O (LCSW, BCCC)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:O
Last Name:MEJIAS
Suffix:
Gender:F
Credentials:LCSW, BCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-8399
Mailing Address - Country:US
Mailing Address - Phone:770-383-2278
Mailing Address - Fax:
Practice Address - Street 1:251 E BROAD ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2206
Practice Address - Country:US
Practice Address - Phone:770-383-2278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0059311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical