Provider Demographics
NPI:1598181901
Name:PATTERSON, TRAKEETA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TRAKEETA
Middle Name:
Last Name:PATTERSON
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 1:618 ASSOLAS CT
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-2497
Mailing Address - Country:US
Mailing Address - Phone:912-398-4914
Mailing Address - Fax:
Practice Address - Street 1:3401 NORMAN BERRY DR STE 255
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30344-5102
Practice Address - Country:US
Practice Address - Phone:404-386-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0066331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical