Provider Demographics
NPI:1629468178
Name:WISE, JOCELYN TANG CHEN (LCSW)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:TANG CHEN
Last Name:WISE
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 1:12 EXECUTIVE PARK DRIVE NE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329
Mailing Address - Country:US
Mailing Address - Phone:404-712-6943
Mailing Address - Fax:404-712-7432
Practice Address - Street 1:12 EXECUTIVE PARK DR NE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2206
Practice Address - Country:US
Practice Address - Phone:404-712-6943
Practice Address - Fax:404-712-7432
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0051251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical