Provider Demographics
NPI:1548401961
Name:RAPHAEL, JOANNE D (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:D
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 AMHERST CT NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1003
Mailing Address - Country:US
Mailing Address - Phone:404-291-9181
Mailing Address - Fax:866-380-4602
Practice Address - Street 1:6100 LAKE FORREST DR STE 450
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:404-291-9181
Practice Address - Fax:404-549-9316
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-14
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0038911041C0700X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator