Provider Demographics
NPI:1578030581
Name:LINEBERGER, MARILYN HAZZARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:HAZZARD
Last Name:LINEBERGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3668 CROSSVALE RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-2823
Mailing Address - Country:US
Mailing Address - Phone:404-435-5074
Mailing Address - Fax:770-987-2122
Practice Address - Street 1:5825 GLENRIDGE DR BLDG 3
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5387
Practice Address - Country:US
Practice Address - Phone:404-508-8889
Practice Address - Fax:770-987-2122
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-28
Last Update Date:2018-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY000840103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical