Provider Demographics
NPI:1619114949
Name:CHASE, DESIREE THANDI (LCSW)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:THANDI
Last Name:CHASE
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 1:595 PIEDMONT AVE NE STE 320-176
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2478
Mailing Address - Country:US
Mailing Address - Phone:404-727-5762
Mailing Address - Fax:
Practice Address - Street 1:867 GREENWOOD AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-3722
Practice Address - Country:US
Practice Address - Phone:404-727-5762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0032431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical