Provider Demographics
NPI:1528360344
Name:FORGOSTON, NICOLE STACEY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:STACEY
Last Name:FORGOSTON
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 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:
Practice Address - Street 1:1100 LAKE HEARN DRIVE, NE STE'S 250 & 500
Practice Address - Street 2:KAISER PERMANENTE SANDY SPRINGS MEDICAL CENTER
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-845-4500
Practice Address - Fax:212-584-5450
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081844104100000X
GACSW005015104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker