Provider Demographics
NPI:1790479921
Name:MORGAN, LILLY RAQUEL
Entity Type:Individual
Prefix:
First Name:LILLY
Middle Name:RAQUEL
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4765 BUTNER RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-1343
Mailing Address - Country:US
Mailing Address - Phone:678-698-5014
Mailing Address - Fax:
Practice Address - Street 1:3008 HATHCOCK RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-1146
Practice Address - Country:US
Practice Address - Phone:678-698-5014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst