Provider Demographics
NPI:1821692245
Name:DOWDELL PETERSON, EBONY (LCSW)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:DOWDELL PETERSON
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 1:3605 SANDY PLAINS RD STE 493
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3068
Mailing Address - Country:US
Mailing Address - Phone:678-538-9614
Mailing Address - Fax:678-538-9613
Practice Address - Street 1:3605 SANDY PLAINS RD STE 493
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3068
Practice Address - Country:US
Practice Address - Phone:678-538-9614
Practice Address - Fax:678-538-9613
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
GACSW007391101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171W00000XOther Service ProvidersContractor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional