Provider Demographics
NPI:1619174463
Name:BATTAGLIA, ANDREA (LSCW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BATTAGLIA
Suffix:
Gender:F
Credentials:LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 COOPER LAKE RD SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1943
Mailing Address - Country:US
Mailing Address - Phone:678-772-3814
Mailing Address - Fax:
Practice Address - Street 1:5604 WENDY BAGWELL PKWY
Practice Address - Street 2:SUITE 411
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-7809
Practice Address - Country:US
Practice Address - Phone:404-246-7470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW003453101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health