Provider Demographics
NPI:1760749824
Name:BEARD-CATHEY, JACQUELINE T (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:T
Last Name:BEARD-CATHEY
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 1:405 FOND DU LAC DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-1117
Mailing Address - Country:US
Mailing Address - Phone:404-375-6900
Mailing Address - Fax:404-393-7767
Practice Address - Street 1:157 BURKE STREET SUITE 119
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4007
Practice Address - Country:US
Practice Address - Phone:678-249-9311
Practice Address - Fax:404-393-7767
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0017161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical