Provider Demographics
NPI:1558427039
Name:WILEY, ELBRENDA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELBRENDA
Middle Name:
Last Name:WILEY
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 1:2041 DOWNS PL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-7849
Mailing Address - Country:US
Mailing Address - Phone:770-323-2093
Mailing Address - Fax:770-323-0063
Practice Address - Street 1:2041 DOWNS PL
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-7849
Practice Address - Country:US
Practice Address - Phone:770-323-2093
Practice Address - Fax:770-323-0063
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0008681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical