Provider Demographics
NPI:1760056600
Name:PHAM, MARIE DE NOEL (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:DE NOEL
Last Name:PHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 PARK DR NE UNIT 524
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-5111
Mailing Address - Country:US
Mailing Address - Phone:404-229-8655
Mailing Address - Fax:
Practice Address - Street 1:520 PARK DR NE UNIT 524
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-5111
Practice Address - Country:US
Practice Address - Phone:404-229-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0092771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical